Tomonori Akasaka1, Seiji Hokimoto2, Daisuke Sueta1, Noriaki Tabata1, Shuichi Oshima3, Koichi Nakao4, Kazuteru Fujimoto5, Yuji Miyao5, Hideki Shimomura6, Ryusuke Tsunoda7, Toyoki Hirose8, Ichiro Kajiwara9, Toshiyuki Matsumura10, Natsuki Nakamura11, Nobuyasu Yamamoto12, Shunichi Koide13, Shinichi Nakamura14, Yasuhiro Morikami15, Naritsugu Sakaino16, Koichi Kaikita1, Sunao Nakamura17, Kunihiko Matsui1, Hisao Ogawa1. 1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 2. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: shokimot@kumamoto-u.ac.jp. 3. Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan. 4. Cardiovascular Center, Kumamoto Saiseikai Hospital, Kumamoto, Japan. 5. National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan. 6. Division of Cardiology, Fukuoka Tokushukai Hospital, Fukuoka, Japan. 7. Kumamoto Red Cross Hospital, Kumamoto, Japan. 8. Division of Cardiology, Minamata City Hospital and Medical Center, Minamata, Japan. 9. Division of Cardiology, Arao City Hospital, Arao, Japan. 10. Division of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Japan. 11. Division of Cardiology, Shin Beppu Hospital, Beppu, Japan. 12. Division of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan. 13. Division of Cardiology, Health Insurance Yatsushiro General Hospital, Yatsushiro, Japan. 14. Division of Cardiology, Health Insurance Hitoyoshi General Hospital, Hitoyoshi, Japan. 15. Division of Cardiology, Kumamoto City Hospital, Kumamoto, Japan. 16. Division of Cardiology, Amakusa Regional Medical Center, Amakusa, Japan. 17. Cardiovascular Center, New Tokyo Hospital, Matsudo, Japan.
Abstract
BACKGROUND: Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS). METHODS AND RESULTS: From August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210). CONCLUSIONS: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.
BACKGROUND: Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS). METHODS AND RESULTS: From August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210). CONCLUSIONS: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.