In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup.
BACKGROUND
Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.


OBJECTIVE
The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).


METHODS
Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally.


RESULTS
In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23-1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74-0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02-5.13).


CONCLUSIONS
There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals.
Tebbe
Ulrich
U
Klinikum Lippe GmbH, Fachbereich Herz-Kreislauf, 32756 Detmold, Germany. ulrich.tebbe@klinikum-lippe.de
Hochadel
Matthias
M
Bramlage
Peter
P
Kerber
Sebastian
S
Hambrecht
Rainer
R
Grube
Eberhard
E
Hauptmann
Karl E
KE
Gottwik
Martin
M
Elsässer
Albrecht
A
Glunz
Hans-Georg
HG
Bonzel
Tassilo
T
Carlsson
Jörg
J
Zeymer
Uwe
U
Zahn
Ralf
R
Senges
Jochen
J
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D013503:Surgery Department, Hospital; D016896:Treatment Outcome