Insiders’ Insights

Angioplasty Debated
Should community hospitals be allowed to perform elective angioplasty without on-site surgical backup? A study at Johns Hopkins Medical Institutions hopes to answer that question. Currently, 28 states say "yes"—at least for some hospitals. But ask this question in New Jersey and you’ll hear markedly different viewpoints.

Joseph E. Parrillo, MD
Chief, Department of Medicine
Director, Cooper Heart Institute
Cooper University Hospital
Camden, NJ

Performing elective angioplasty or stenting without surgical backup is contraindicated. An observational database of 625,000 Medicare patients published in the Journal of the American Medical Association showed that elective angioplasty at U.S. hospitals without surgical backup have a 38% increase in mortality, which would translate to an additional 1,000 to 2,000 deaths per year. A serious complication can occur during angioplasty. The only question is how often. If it is 1 or 2 in 1,000, and on-site surgical backup could reverse such a complication, then on-site surgical backup should be available. In New Jersey, we have 18 full-service centers with elective angioplasty and on-site cardiac surgical backup that are within 30 minutes of all New Jersey residents. Perhaps in Montana this is a reasonable practice, but it is not appropriate in New Jersey.

James Dwyer, DO
Executive Vice President and Chief Medical Officer
Virtua Health
Marlton, NJ

Community-based hospitals should be allowed to provide elective angioplasty. It has become an increasingly safe procedure and represents an important element in the care of patients with coronary artery disease. It allows us to provide more comprehensive, high-quality services for our patients. Emergent angioplasty is an important treatment for a patient who is having an acute heart attack. Healthcare organizations have great difficulty securing the staff and supporting the needs of this type of program without the volume of cases provided through elective angioplasty. Data suggests that this can be done in facilities without on-site surgical backup without any increased risk to the patient, and as such, we feel that having elective angioplasty is an important service to provide to our patients.

—Carrie Vaughan