Onsite Cardiac Surgery Backup Research Articles

TCT-682 Outcomes in Patients Undergoing Rotational Atherectomy Assisted PCI in Centers Without Onsite Cardiac Surgery Backup: A Multicenter Study in an Australian Cohort

TCT-682 Outcomes in Patients Undergoing Rotational Atherectomy Assisted PCI in Centers Without Onsite Cardiac Surgery Backup: A Multicenter Study in an Australian Cohort

Iatrogenic Left Main Coronary Artery Dissection in a Non-Primary Percutaneous Intervention Setup without On-Site Cardiac Surgery Backup

Iatrogenic Left Main Coronary Artery Dissection in a Non-Primary Percutaneous Intervention Setup without On-Site Cardiac Surgery Backup

Is a cardiac catheterization procedure at hospitals without on-site surgical backup safe?

Percutaneous cardiac catheterization procedures have now become an established and preferable method. Initially, these procedures were performed at clinical sites with surgical backup as complication rates and need of urgent surgery were high. With the improvement in catheter technique, experienced operators and the development of new devices, overall complication rates of catheterization are low and emergency cardiac surgery has become an increasingly rare event. The aim of the study was to evaluate the procedural outcomes for cardiac interventions in a tertiary-level hospital without onsite cardiac surgery backup. This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous cardiac interventions, including both diagnostic as well as therapeutic interventions, between September 2013 and August 2015 were included in this study. Total 692 percutaneous cardiac interventions were performed. The mean age was 61.9 ± 18.3 years. 439(63.52%) procedures were carried out in men. PCI was done in 189(27 .31%). Percuteneous transvenous mitral comissurotomy was done in 49(7.08%) cases, coronary angiogram was done in 395(57.08%), permanent pacemaker insertion in 29(4.20%), peripheral angiogram in 16(2.30%), pericardiocentesis in 14(2 .02%).Primary PCI was done in 62(32.88%). The most frequent indication for PCI was STEMI 106(56.16%). Complications like Post-procedural cardiogenic shock in 4 (2.11%) cases, arrhythmias and minor complications in 7 (3.70%), and death in 4 (2.11%) patients was witnessed. Similarly, periprocedural MI and contrast induced nephropathy (CIN) requiring dialysis stroke or transient ischemic attack were not noted.Cardiac tamponade was observed in 1 (2.02%) patient during PTMC. There was no need of emergency cardiac surgery Percutaneous cardiac intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup.

Is a cardiac catheterization procedure at hospitals without on-site surgical backup safe?

<p>Percutaneous cardiac catheterization procedures have now become an established and preferable method. Initially, these procedures were performed at clinical sites with surgical backup as complication rates and need of urgent surgery were high. With the improvement in catheter technique, experienced operators and the development of new devices, overall complication rates of catheterization are low and emergency cardiac surgery has become an increasingly rare event. The aim of the study was to evaluate the procedural outcomes for cardiac interventions in a tertiary-level hospital without onsite cardiac surgery backup. This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous cardiac interventions, including both diagnostic as well as therapeutic interventions, between September 2013 and August 2015 were included in this study. Total 692 percutaneous cardiac interventions were performed. The mean age was 61.9 ± 18.3 years. 439(63.52%) procedures were carried out in men. PCI was done in 189(27 .31%). Percuteneous transvenous mitral comissurotomy was done in 49(7.08%) cases, coronary angiogram was done in 395(57.08%), permanent pacemaker insertion in 29(4.20%), peripheral angiogram in 16(2.30%), pericardiocentesis in 14(2 .02%).Primary PCI was done in 62(32.88%). The most frequent indication for PCI was STEMI 106(56.16%). Complications like Post-procedural cardiogenic shock in 4 (2.11%) cases, arrhythmias and minor complications in 7 (3.70%), and death in 4 (2.11%) patients was witnessed. Similarly, periprocedural MI and contrast induced nephropathy (CIN) requiring dialysis stroke or transient ischemic attack were not noted.Cardiac tamponade was observed in 1 (2.02%) patient during PTMC. There was no need of emergency cardiac surgery Percutaneous cardiac intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup.</p>

Clinical Impact of Telemedicine Network System at Rural Hospitals Without On-Site Cardiac Surgery Backup.

In Japan, catheterization laboratories are available in each medical service area. However, cardiovascular centers capable of surgical procedures are concentrated in urban areas. Critically ill patients with complex coronary lesions must be transferred to receive advanced medical care. Interhospital conferencing is necessary for an optimal patient transfer. We investigated the benefit and utility of a Digital Imaging and Communications in Medicine (DICOM) telemedicine network at a rural hospital without on-site cardiac surgery backup in Japan. The Kumamoto telemedicine network consists of 2 high-volume centers and 12 rural low-volume hospitals without on-site cardiac surgery. Between January 2010 and December 2014, 293 teleconferences were conducted. At the Aso Medical Center, a low-volume hospital, teleconferences were carried out in 48 cases (30 coronary artery disease, 6 peripheral artery disease, 3 aortic aneurysm, 3 deep vein thrombosis, 2 inflammatory aortitis, 1 annuloaortic ectasia, 1 cardiac tamponade, 1 myocarditis, and 1 heart failure). After the conferences were initiated, 10 cases (20.8%) were transferred to the high-volume center. We investigated the prevalence of patient transfer before and after network system deployment. Telemedicine-based collaborative care significantly decreased the frequency of patient transfers from the Aso area. The Kumamoto telemedicine network enabled open communication between distant hospitals. This collaboration has the potential to improve cardiac care in rural areas.

Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup

BackgroundBased on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS). Methods and resultsFrom August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210). ConclusionsThere is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

Thirty years of standalone percutaneous coronary interventions: A 23,261 case experience from a Canadian tertiary referral centre

Background: When percutaneous coronary intervention (PCI) was first performed >35 years ago, on-site cardiac surgery backup for PCI failure was deemed essential. As techniques improved and primary PCI became the preferred reperfusion strategy for acute myocardial infarction, many standalone PCI programs originally established to facilitate access to primary PCI started to perform elective PCI, which remains a Class IIb recommendation in American College of Cardiology Foundation/American Heart Association/Society for Cardiac Angiography and Interventions guidelines. Two recent United States studies showed that outcomes of elective PCI in standalone centres were noninferior to those with on-site cardiac surgery. The Royal Alexandra Hospital in Edmonton (Alberta) performed the first standalone PCI in Canada in 1981. Objectives: The authors describe their first 30 years’ experience with PCI – the largest single-centre standalone experience reported to date. Methods: Patient and procedural data have been collected since the first standalone PCI in 1981, evolving from paper records to a computer database and, in 1995, a provincial database. Quality assurance and peer review in collaboration with the regional cardiac surgery program was established from the outset. Results: The success, emergency coronary bypass and death rates for 23,261 standalone PCIs performed between 1981 and 2011 were 96.0%, 0.2% and 0.5%, respectively. For 9068 PCIs performed between 2007 and 2011 (a period that most reflects contemporary practice), the rates were 96.5%, 0.04% and 0.6%, respectively. These results compare favourably with PCI results reported in literature, irrespective of the presence or absence of on-site cardiac surgery. Conclusions: With high volumes and an experienced team, standalone PCIs can be performed safely with excellent success and low complication rates.

Abstract 14873: Is There Difference in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) between Hospitals With and Without Onsite Cardiac Surgery Backup?

Background: Based on 2011 ACCF/AHA/SCAI PCI guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent data suggests that there is no significant difference in clinical outcomes following primary or elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI to ACS. Methods: From Aug 2008 to March 2011, subjects (n=2288) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=1954) or without (n=334) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored other events those were non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG. Results: There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery (9.6%vs9.5%; P=0.737). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite cardiac surgery (22.1%vs12.9%; P&lt;0.001). Kaplan-Meier analysis for primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.943). By cox proportional hazards model analysis for primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 0.969, 95%CI 0.704-1.333; P=0.845). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (6.9% vs 8.0%; P=0.544). Conclusions: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

Clinical outcomes of percutaneous coronary intervention (PCI) at hospital with or without onsite cardiac surgery backup

Based on 2011 ACCF/AHA/SCAI PCI guidelines, it is recommended that PCI should be performed at a hospital with onsite cardiac surgery [1]. But, recent data suggests that there is no difference in clinical outcomes following primary [2,3] or elective PCI [4,5] between hospitals with or without onsite cardiac surgery [6]. However, this has not been determined for Japan. We examined the impact of onsite cardiac surgery on clinical outcomes following PCI in Japan.

Percutaneous Coronary Intervention without onsite Cardiac Surgery Backup

Mechanical revascularization by percutaneous coronary interventions has now become an established and preferable method of revascularization in patients with acute coronary syndromes. The aim of the study was to identify the clinical indications for percutaneous coronary interventions and in-hospital outcomes of percutaneous coronary interventions in a tertiary-level hospital without onsite cardiac surgery backup. This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous coronary interventions, including both primary as well as elective percutaneous coronary interventions, between March 2011 and December 2012 were included in the study. Total 101 percutaneous coronary interventions were performed. The mean age was 58.9 ± 12.3 years. The most frequent indication was ST-elevation myocardial infarction 72 (71.3%). Proximal artery stenting were performed in 39 (38.5%) and the non proximal artery stenting in 62 (61.5%). The outcomes were mortality 5 (4.9%), periprocedural myocardial infarction 2 (1.9%), cardiogenic shock 6 (5.9%), contrast induced nephropathy requiring dialysis in 3 (2.9%), minor complications which were managed conservatively in 13 (12.9%). Percutaneous coronary intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup. ST-elevation myocardial infarction was the major indication and cardiogenic shock was the major complication observed, and non proximal artery stenting was more common than the proximal artery stenting.

Primary percutaneous coronary intervention without on-site cardiac surgery backup in unselected patients with ST-segment-Elevation Myocardial Infarction: The RIvoli ST-segment Elevation Myocardial Infarction (RISTEMI) registry

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS). The Infermi Hospital in Rivoli, Italy, is a community hospital without OCS with a high volume catheterization laboratory (>800 PCI and >150 primary PCI per year), which provides a 24-hour primary PCI service to a population of 583.000 and is only 14 km far from the nearest OCS hospital. We analyzed clinical and procedural data, as well as 30-day outcome, of all STEMI patients treated by primary PCI within 12 hours from symptom onset. From September 2001 to June 2010, 1302 patients with a suspect of STEMI underwent urgent coronary angiography. Of these, 1251 (96.1%), underwent primary PCI. A successful myocardial revascularization was achieved in 1172 patients (93.7%). Thirty-day mortality occurred in 7.1%. Multivariate predictors of 30-day mortality were: age ≥75 years (OR 3.96, p=0.0003), left ventricular ejection fraction ≤40% (OR 35.0, p=0.02), cardiogenic shock at presentation (OR 33.4, p<0.0001), anterior STEMI (OR 1.82, p=0.036) and total ischemic time ≤3 hours (OR 0.55, p=0.05). Primary PCI is a reperfusion strategy feasible and effective in unselected high-risk STEMI patients even in hospitals without OCS with a high volume of routine and emergency interventional procedures.

Effect of volume of percutaneous coronary intervention on clinical outcomes in patients with acute myocardial infarctions in hospitals with and without onsite cardiac surgery backup

Effect of volume of percutaneous coronary intervention on clinical outcomes in patients with acute myocardial infarctions in hospitals with and without onsite cardiac surgery backup

AS-012 Clinical Outcomes of Primary Percutaneous Coronary Interventions for Acute Myocardial Infarctions in Hospitals With and Without Onsite Cardiac Surgery Backup

Due to the development of percutaneous coronary intervention (PCI) technology, the need for coronary bypass graft surgery (CABG) in acute myocardial infarction (AMI) has decreased. We compared the clinical outcomes of patients with AMI undergoing PCI who were treated at hospitals with and without onsite cardiac surgery backup (CSB) in South Korea.

Outcomes of Nonemergent Percutaneous Coronary Intervention With and Without On-site Surgical Backup: A Meta-Analysis

Despite major advances in percutaneous coronary intervention (PCI) techniques, the current guidelines recommend against elective PCI at hospitals without on-site cardiac surgery backup. Nonetheless, an increasing number of hospitals without on-site cardiac surgery in the United States have developed programs for elective PCI. Studies evaluating outcome in this setting have yielded mixed results, leaving the question unanswered. Hence, a meta-analysis comparing outcomes of nonemergent PCI in hospitals with and without on-site surgical backup was performed. A systematic review of literature identified four studies involving 6817 patients. Three clinical end points were extracted from each study and included in-hospital death, myocardial infarction, and the need for emergency coronary artery bypass grafting. The studies were homogenous for each outcome studied. Therefore, the combined relative risks (RRs) across all the studies and the 95% confidence intervals (CIs) were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error less than 0.05 was considered to be statistically significant. Compared with facilities with on-site surgical backup, the risk of in-hospital death (RR, 2.7; CI, 0.6-12.9; P = 0.18), nonfatal myocardial infarction (RR, 1.3; CI, 0.7- 2.2; P = 0.29), and need of emergent coronary artery bypass grafting (RR, 0.46; CI, 0.06- 3.1; P = 0.43) was similar in those lacking on-site surgical backup. The present meta-analysis suggests that there is no difference in the outcome with regard to risk of nonfatal myocardial infarction, need for emergency coronary artery bypass grafting, and the risk of death in patients undergoing elective PCI in hospitals with and without on-site cardiac surgery backup.

In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup

Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak. The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB). Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally. In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23-1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74-0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02-5.13). There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals.

Nonemergent coronary angioplasty without on-site surgical backup: A randomized study evaluating outcomes in low-risk patients

Background Percutaneous coronary intervention (PCI) in nonemergent patients with coronary artery disease in hospitals without on-site cardiac surgery backup is still controversial. To prospectively evaluate a set of low procedural risk criteria for PCI, patients with stable or unstable angina were randomized to treatment in either a community hospital, which had all supportive services except for on-site cardiac surgery, or a regional surgical hospital 213 km away. Methods and results During a 4-year period, 609 (57%) of 1064 consecutive patients with stable or unstable angina who underwent coronary angiography at a teaching community hospital in Norway fulfilled the predefined low-risk criteria for PCI. The patients were randomized to treatment at either the community hospital (n = 305) or at the regional hospital (n = 304). The angiographic success rate (96% at both hospitals) and number of major periprocedural complications (overall 0.3%) were equal at the 2 hospitals. In particular, there were no deaths or need for urgent transfer to cardiac surgery. At 6 months of clinical follow-up, there was a significant higher major adverse cardiac event rate rate at the community hospital, compared with the regional hospital (6.9% vs 2.3%, respectively, P = .03) because of more repeat target vessel revascularizations. Improvement in angina functional class and exercise capacity was similar in both groups. The excluded high-risk PCI patients had higher 6-month major adverse cardiac event compared with all low-risk patients (8.4% vs 4.3%, respectively, P = .01). Conclusion Selected nonemergent patients can, based on angiography, safely undergo PCI at hospitals without cardiac surgery backup. The angiographic selection criteria identified high-risk patients, which had worsened outcome at 6 months of follow-up.