Abstract
Background: Elective percutaneous coronary interventions (PCI) are routinely performed at hospitals with on-site cardiac surgery (CS). Smce 1999, elective PCI has been performed at lmmanuel St. Josephs Hospital (ISJ). a community hospital without on-site CS, with telemedicine support from Saint Matys Hospital (SMH). Methods: 215 PCI patients at ISJ were matched on clinical and lesion criteria to 430 PCI patients at SMH. Clinical outcomes assessed included procedural success (~20% residual stenosis and without in-hospital death, myocardial infarction, coronary bypass surgery, or repeat PCI), and target vessel failure rates at 1 year (any death. myocardial infarction, or target vessel revascularization). Economic outcomes included billed charges for room and board, medications, supplies, laboratory, and hospital length of stay. Results: Procedural success rates were similar between groups (ISJ 99.0%; SMH 97%). Target vessel failure rates were also similar between groups at 1 year follow-up (ISJ 16%; SMH 16%, P=O.80). Results of the economic comparison are shown in the table. Patients undergoing PCI at ISJ had significantly higher charges for medication and supplies reflecting higher utilization of stents (93% versus 86%) and glycoprotein Ilb/llla inhibitors (88% versus 57%). Conclusions: Favorable clinical outcomes can be achieved at a hospital without on-site CS at additional cost. Economic analyses are ongoing lo assess the relative cost-effectiveness of providing PCI without on-site CS.
Published Version
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