TRENDS IN PCI FOR PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AT ONTARIO CARDIAC CENTRES WITH AND WITHOUT ON-SITE CARDIAC SURGERY

Abstract

In order to increase the accessibility of Percutaneous Coronary Interventions (PCI) for patients in Ontario, there has been an increase in the number of PCI capable centres without on-site cardiac surgery across the Province in recent years. The objective of this analysis was to describe the volumes, characteristics and treatment times of patients undergoing ST-Segment Elevation Myocardial Infarction (STEMI) related procedures at PCI capable hospitals with (OSS) and without (no-OSS) on-site surgery. The Cardiac Care Network of Ontario maintains a provincial registry of all PCI procedures across Ontario. Data on all procedures performed on patients with a diagnosis of STEMI and undergoing cardiac catheterization within 24 hours of diagnosis were captured on a standardized PCI/STEMI case report form. Patients for this analysis were categorized as Primary PCI, Rescue PCI (emergency PCI for failed fibrinolysis) or Pharmaco-invasive PCI (routine PCI within 24 hours of fibrinolysis). Between April 1 2011 and March 31 2014, 14681 STEMI PCI procedures were performed at 16 PCI sites (OSS=11; no-OSS=5) (see Table 1). The number and proportion of Ontario STEMI cases performed at no-OSS centres over three years were (2011-2012: n=481(13.2%), 2012-2013: n=711(17.0%), 2013-2014: n=1100(24%). During the same period, the number of STEMI cases at OSS centres remained stable. Baseline variables and overall crude treatment times (door to balloon for Primary PCI) were comparable between OSS and no-OSS sites (84 min vs 83 min). These data suggest broader access to emergency PCI for STEMI patients across Ontario over the time period of interest. The greater provision of STEMI PCI has been driven by over a 2-fold increase in the number of cases performed at no-OHS centers, which now provide approximately one-quarter of all STEMI PCI in the Province.