Scot Garg1, Simon G Anderson2, Keith Oldroyd3, Colin Berry4, Connor A Emdin5, Sanne A E Peters5, Nick E J West6, Damian Kelly7, Kanarath Balachandran8, John McDonald8, Ravi Singh8, Sen Devadathan9, Simon Redwood10, Peter F Ludman11, Kazem Rahimi5, Mark Woodward12. 1. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. Electronic address: scot.garg@elht.nhs.uk. 2. Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom. 3. West of Scotland Regional Heart & Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom. 4. West of Scotland Regional Heart & Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom. 5. The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom. 6. Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom. 7. Derby Hospitals NHS Trust, Derby, United Kingdom. 8. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. 9. Royal Cornwall Hospitals Trust, Truro, United Kingdom. 10. Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom. 11. University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 12. The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. OBJECTIVES: The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. METHODS: A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. RESULTS: Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p < 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients. CONCLUSIONS: PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.
BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. OBJECTIVES: The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. METHODS: A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. RESULTS: Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p < 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients. CONCLUSIONS: PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.