Percutaneous Coronary Interventions in Facilities without OnSite Cardiac
- Slides: 10
Percutaneous Coronary Interventions in Facilities without On-Site Cardiac Surgery: A Report from the National Cardiovascular Data Registry (NCDR) ACC/SCAI – i 2 Summit Late Breaking Clinical Trials March 29, 2008
Study Population NCDR Cath. PCI Registry Consecutive PCI cases January 1, 2004 to March 30, 2006 308, 161 patients 465 centers OFF-SITE Surgery Back-Up 9, 029 patients 61 centers ON-SITE Surgery Back-up 299, 132 patients 404 centers
MI Presentation
Procedural Success and Complications
Observed Outcomes: All PCI Patients (P<. 0001) (P=0. 3560) (P=0. 8838) (P<. 0001)
Risk Adjusted Outcomes Odds Ratio (OR): outcomes for patients at On-Site (vs. Off-Site) facilities adjusting for site correlations and potential confounding variables
Conclusions • Compared to On-Site PCI centers, Off-Site PCI programs participating in the NCDR: Ø Have smaller bed capacities. Ø Are predominantly located in rural and suburban areas. Ø Have lower annual PCI volume. Ø Treat a higher percentage of patients who present with subsets of MI (STEMI and NSTEMI). Ø Have better reperfusion times in primary PCI.
Conclusions • Compared to On-Site PCI centers, Off-Site PCI programs have similar observed: Ø Procedure success Ø Morbidity Ø Emergency surgery rates Ø Mortality in cases that require emergency surgery • The risk-adjusted mortality rate in Off-Site facilities was comparable to those PCI centers that have cardiac surgery on-site.
Implications • Off-Site PCI centers can provide excellent care to patients – if the program is developed with thoughtfulness and safety. • Our results are derived from PCI programs who have demonstrated a strong commitment to quality and attention to key structure, process, and outcomes measurements. Without such a commitment, similar results might not be achievable.
Implications • The results of our study should not be extrapolated to encourage the wide-spread proliferation of Off-Site PCI programs. • Our study confirms the safety of an Off-Site PCI strategy at centers where rigorous clinical, operator, and institutional criteria are in place and are monitored to assure high quality outcomes.
