Title: Percutaneous Coronary Interventions at Facilities Without On-Site Cardiac Surgery: A Report From the National Cardiovascular Data Registry (NCDR)
Topic: Interventional Cardiology
Presenter: Michael A. Kutcher
Author(s): Karen Alexander
Summary

In an effort to assess the safety of PCI carried out at hospitals without onsite Cardiac Surgery， an analysis of 308，161 patients from the NCDR CathPCI registry has found no difference in risk adjusted mortality or complication rates in 9，029 patients treated at hosp without onsite Cardiac Surgery compared with 299，131 patients at hosp with onsite surgery (adjusted mortality RR 1.08 (0.86-1.35) with comparably low rate of overall complications (6.4% v. 6.3%) and emergency surgery (0.3% v. 0.4%) in both.

摘要

为评价在无外科支持下行PCI术的安全性，全美心血管病注册研究对308161名患者进行了统计分析研究，共有9029名患者在无外科支持的医学中心接受了PCI术，299131名患者在有外科支持的医学中心接受了PCI术，结果表明两组患者均有较低的并发症发生率（6.4％VS6.3％）和紧急外科搭桥手术率（0.31％VS0.37％）Background

Some hospitals without on-site cardiac surgery develop PCI programs to provide rapid primary PCI for STEMI and to increase availability of elective PCI to patients residing in geographically underserved areas. There are few published studies that describe the safety or practice of PCI in this setting.

Study Design

A specific analysis of the NCDR CathPCI database was carried out. The Cath PCI registry involves 465 hospitals， 404 with on site cardiac surgery and 61 without. In addition to standard data collection， a data clarification project was performed to determine the outcomes of patients after transfer as well as the characteristics of the centers and operators at locations without on-site surgery. The procedural and lesion characteristics， the proportion of primary or elective PCI， and the outcomes of emergency surgery were described. In addition， mortality was adjusted before and after patients with missing outcomes were assumed to have died.

Results and Conclusions

The majority of PCI centers without on-site surgical backup performed both elective and primary PCI (80%)， although the proportion of patients undergoing primary PCI is higher in off-site centers (50.6% v. 28.9%). Over half of off-site PCI centers were within 20 minutes of surgical backup， and the majority of off-site PCI operators (80%) also worked at cardiac centers with surgical backup. Procedural characteristics did not differ， and less than 0.5% of patients at either off- or on-site PCI centers required emergency surgery. Crude mortality was higher in the off-site patients overall (1.8% v. 1.2%， p<0.0001)， but differences in mortality were no longer significant after adjustment RR 1.08 (0.86-1.35).

Perspective

This study provides the largest clinical analysis and comparison of diverse PCI centers in the United States with and without on-site cardiac surgery support. The performance of timely reperfusion with primary PCI in areas without ready access to full service cardiac centers is essential. This study finds that the majority of cases in centers without on-site surgery are still elective， and many centers are within 20 minutes of hospitals with cardiac surgery capabilities. The occurrence of emergency surgery is rare regardless of PCI location; after adjustment， there is no difference in mortality in patients transferred for emergency surgery or overall at centers without on-site surgery.