Percutaneous coronary intervention is more unsafe if there are no onsite cardiac surgery facilities

Abstract

QuestionAre outcomes comparable when percutaneous coronary interventions are delivered in hospitals with and without onsite cardiac surgery programmes?Study designCohort study.Main resultsMost percutaneous coronary interventions (PCI) performed across 1121 institutions were in hospitals with onsite cardiac surgery programmes (8168/61766 [98%] of PCIs). Overall, people having PCIs in hospitals without cardiac surgery facilities were more likely to have been admitted in emergency, have acute MI and have undergone a rescue PCI. Mortality following PCI was significantly higher in hospitals without surgery facilities compared with hospitals with surgery facilities (20393 [3.3%] with onsite surgery v 492 [6%] without onsite surgery; OR 1.29, 95% CI 1.14 to 1.47). Subgroup analysis showed that elective, rather than emergent PCI, was responsible for increased mortality in hospitals without surgery facilities (mortality among people undergoing emergency/rescue PCI: 4209 [12.2%] with onsite surgery v 202 [11.3%] without onsite surgery; OR 0.93, 95% CI 0.80 to 1.08; mortality in people undergoing elective PCI: 16184 [2.8%] with onsite surgery v 290 [4.6%] without onsite surgery; OR 1.38, 95% CI 1.14 to 1.67).Authors’ conclusionsOdds of death were 38% greater in people having non-primary/non-rescue PCI in hospitals without onsite cardiac surgery programmes than in hospitals with onsite facilities. There was no significant difference in mortality in the primary/rescue cohort.