Outcome of percutaneous coronary intervention in hospitals with and without on-site cardiac surgery standby.
OBJECTIVE
To compare characteristics and outcome of patients undergoing percutaneous coronary intervention (PCI) in clinics with (WSB) or without (NOSB) on-site cardiac surgery backup.


METHODS
Analysis according to hospital, type of prospectively collected data of all patients who underwent PCI during 2000-3.


METHODS
The Swedish Coronary Angiography and Angioplasty Registry covers all PCI procedures performed in Sweden.


METHODS
34,363 patients underwent PCI between January 2000 and December 2003. 8838 procedures were performed in NOSB (mean age of patients was 64.5 years) hospitals and 25,525 in WSB (mean age of patients was 64.1 years) hospitals (p = 0.002).


RESULTS
More patients in NOSB hospitals had diabetes (17.8% vs 16.8%; p = 0.03). Other clinical characteristics (previous infarct, previous coronary artery bypass graft (CABG)) also showed a tendency towards worse patients being treated in NOSB hospitals. However, there was a higher percentage of patients with ST-segment elevation myocardial infarction (18% vs 9.7%; p<0.01) in WSB hospitals. After adjusting for differences in baseline risk no significant differences regarding outcome (30-day mortality, 1-year mortality, stroke and emergency CABG) were observable between WSB and NOSB hospitals. This applied to elective and non-elective procedures.


CONCLUSIONS
On the basis of these data it does not seem warranted to recommend against percutaneous transluminal coronary angioplasty in NOSB hospitals.
Carlsson
Jörg
J
Department of Internal Medicine, Division of Cardiology, Länssjukhuset, Kalmar, Sweden. jorgc@ltkalmar.se
James
Stefan N
SN
Ståhle
Elisabeth
E
Höfer
Sebastian
S
Lagerqvist
Bo
B
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology; D013531:Surgicenters / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome