5 years ago

Non-Primary PCI at Hospitals without Cardiac Surgery On-Site: Consistent Outcomes for All?

The CPORT-E trial showed the non-inferiority of non-primary PCI at hospitals without cardiac surgery on-site (SoS) compared to hospitals with SoS for 6-week mortality and 9-month major adverse cardiac events (MACE). However, target vessel revascularization (TVR) was increased at non-SoS hospitals. Therefore, we aimed to determine the consistency of the Cardiovascular Patient Outcomes Research Team Non-Primary PCI (CPORT-E) trial findings across the spectrum of enrolled patients. Methods Post-hoc subgroup analyses of 6-week mortality and 9-month MACE, defined as the composite of death, Q-wave myocardial infarction, or TVR. Comparison of patients with and without 9-month TVR and rates of related outcomes. Results There was no interaction between SoS status and clinically relevant subgroups for 6-week mortality or 9-month MACE (P for any interaction=0.421 and 0.062, respectively). In addition to increased 9-month rates of TVR and diagnostic catheterization at hospitals without SoS, non-TVR was also increased (2.7% vs 1.9%, P =.002); there was no difference in myocardial infarction-driven TVR, non-TVR, or diagnostic catheterization. Predictors of 9-month TVR included intra-aortic balloon pump use, any index PCI complication, and three-vessel PCI, while predictors of freedom from TVR included SoS, discharge on a P2Y12 inhibitor, and stent implantation. Conclusions The non-inferiority of non-primary PCI at non-SoS hospitals was consistent across clinically relevant subgroups. Elective PCI at an SoS hospital conferred a TVR benefit which may be related to a lower rate of referral for diagnostic catheterization for reasons other than myocardial infarction.

Publisher URL: www.sciencedirect.com/science

DOI: S0002870317303538

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