Back to Search
Start Over
Outcomes of PCI at hospitals with or without on-site cardiac surgery
- Source :
- The New England journal of medicine. 366(19)
- Publication Year :
- 2012
-
Abstract
- Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery.We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months.A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01).We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Myocardial Infarction
Revascularization
medicine
Humans
Myocardial infarction
Angioplasty, Balloon, Coronary
Coronary Artery Bypass
Emergency Treatment
Aged
business.industry
Mortality rate
Absolute risk reduction
General Medicine
Middle Aged
medicine.disease
Confidence interval
United States
Surgery
Cardiac surgery
Treatment Outcome
Conventional PCI
Retreatment
Female
Cardiology Service, Hospital
Outcomes research
business
Subjects
Details
- ISSN :
- 15334406
- Volume :
- 366
- Issue :
- 19
- Database :
- OpenAIRE
- Journal :
- The New England journal of medicine
- Accession number :
- edsair.doi.dedup.....6f0d2ae62f48fe78bb1bb63e7f1d84ec