Abstract
Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (−) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan–Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.
Highlights
Percutaneous coronary intervention (PCI) centers without onsite cardiac surgical support are currently available
The European Society of Cardiology (ESC) guideline on myocardial revascularization mentioned that non-emergency high-risk PCI procedures should only be performed by adequately experienced operators at centers that have access to circulatory support and intensive care treatment [14]
The SHINANO registry is a prospective, multicenter, observational registry of patients with any coronary artery disease (CAD) diagnosis, including stable angina, segment elevation myocardial infarction (STEMI), nonSTEMI (NSTEMI), and unstable angina (UA), undergoing PCI at hospitals located in the Nagano prefecture, Japan
Summary
Percutaneous coronary intervention (PCI) centers without onsite cardiac surgical support are currently available. Heart and Vessels the latest version of the Japanese guideline recommends (class IIa recommendation) that primary PCI for ST-segment elevation myocardial infarction (STEMI) should be performed at centers without onsite backup cardiac surgery facilities (level of evidence, B) [12, 13]. The European Society of Cardiology (ESC) guideline on myocardial revascularization mentioned that non-emergency high-risk PCI procedures should only be performed by adequately experienced operators at centers that have access to circulatory support and intensive care treatment (class IIa recommendation; level of evidence, C) [14]. PCI is an issue of concern at institutions without onsite surgical support in emergent and complex cases. Many institutions without onsite cardiac backup surgical facilities have already been established; it is believed that there are some differences in the experience of PCI at these institutions
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