American Heart Journal
American Heart Journal
5 years ago

Primary percutaneous coronary intervention at centers with and without on-site surgical support: Insights from the blue cross blue shield of Michigan cardiovascular consortium (BMC2)

Primary percutaneous coronary intervention (PPCI) is being increasingly performed nationally at sites without on-site cardiac surgery; however, recent guidelines only provide a Class IIa recommendation for this practice. The state of Michigan has permitted PPCI without on-site surgery under a closely monitored system that mandates auditing of all procedures and quarterly feedback on quality and outcomes. Objective This study sought to compare outcomes of patients undergoing PPCI at centers with and without on-site surgery in the state of Michigan. Methods Consecutive patients who underwent PPCI at 47 hospitals in Michigan from January 2010 to December 2015 were included. From this cohort, 4091 patients from sites with and without on-site cardiac surgery were propensity matched in a 1:1 fashion to compare baseline characteristics, procedural details, and in-hospital outcomes. Results Of the 25,886 PPCI's performed at 47 hospitals in Michigan from 2010 to 2015, 21,610 (83.5%) were performed at sites with on-site surgery and 4276 (16.5%) at sites without on-site surgery. Using propensity score matched cohorts (4091 patients for each site type) we found no significant differences in baseline characteristics. Overall mortality (5.4% vs. 5.8%; P =.442), composite outcome of in-hospital mortality, contrast-induced nephropathy, bleeding and stroke (13.8% vs. 12.8%; P =.152), and individual outcomes within the composite group showed no significant differences. Additionally, there were no clinically meaningful differences in rates of urgent/emergent CABG or length of stay. Significant differences, however, were found in procedural access site, antiplatelet therapy, contrast volume, and anticoagulant strategy. Conclusions Primary PCI performed at centers with and without cardiac surgery have comparable outcomes and complication rates, when performed with close monitoring of quality and outcomes.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317303162

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