PCI Safe in Hospitals Lacking Cardiac Surgery Units

With adequate preparation, community hospitals that lack cardiac surgery units can safely perform elective angioplasties or percutaneous coronary interventions (PCI) with no increase in either patient mortality at six weeks or adverse cardiac events at nine months, compared with hospitals that do, according to a large and potentially controversial report.

The study randomly assigned 14,149 patients to receive PCI at a hospital without on-site cardiac surgery, as long as it met certain criteria, and 4,718 patients to undergo the procedure at a hospital cardiac surgery capability. The trial involved more than 60 hospitals in 10 states.

There was no significant difference in adverse outcomes at six weeks or nine months, although there was a small increase in the need for target vessel revascularization in patients who received PCI at hospitals without on-site cardiac surgery.

The report could be interpreted as evidence that smaller or rural community hospitals without cardiac surgery could launch elective PCI programs, or petition state regulatory agencies with rules prohibiting the practice to reconsider, so their patients would not have to be sent to hospitals outside their local areas.

The study, led by Thomas Aversano, MD, an associate professor of cardiology at Johns Hopkins University and colleagues, was presented at the American College of Cardiology annual meeting in Chicago and is published in the March 29 edition of the New England Journal of Medicine.