title: Outcomes of nonemergent percutaneous coronary intervention with and without on-site surgical backup: a meta-analysis.
abstract: Despite major advances in percutaneous coronary intervention (PCI) techniques, the current guidelines recommend against elective PCI at hospitals without on-site cardiac surgery backup. Nonetheless, an increasing number of hospitals without on-site cardiac surgery in the United States have developed programs for elective PCI. Studies evaluating outcome in this setting have yielded mixed results, leaving the question unanswered. Hence, a meta-analysis comparing outcomes of nonemergent PCI in hospitals with and without on-site surgical backup was performed. A systematic review of literature identified four studies involving 6817 patients. Three clinical end points were extracted from each study and included in-hospital death, myocardial infarction, and the need for emergency coronary artery bypass grafting. The studies were homogenous for each outcome studied. Therefore, the combined relative risks (RRs) across all the studies and the 95% confidence intervals (CIs) were computed using the Mantel-Haenszel fixed-effect model. A two-sided alpha error less than 0.05 was considered to be statistically significant. Compared with facilities with on-site surgical backup, the risk of in-hospital death (RR, 2.7; CI, 0.6-12.9; P = 0.18), nonfatal myocardial infarction (RR, 1.3; CI, 0.7- 2.2; P = 0.29), and need of emergent coronary artery bypass grafting (RR, 0.46; CI, 0.06- 3.1; P = 0.43) was similar in those lacking on-site surgical backup. The present meta-analysis suggests that there is no difference in the outcome with regard to risk of nonfatal myocardial infarction, need for emergency coronary artery bypass grafting, and the risk of death in patients undergoing elective PCI in hospitals with and without on-site cardiac surgery backup.
authors.affiliation: Department of Cardiology, Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL 60064, USA. drparamsingh@gmail.com
authors.forename: Param Puneet
authors.initials: PP
authors.lastname: Singh
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.forename: Updesh Singh
authors.initials: US
authors.lastname: Bedi
authors.forename: Sasikanth
authors.initials: S
authors.lastname: Adigopula
authors.forename: Sarabjeet
authors.initials: S
authors.lastname: Singh
authors.forename: Vamsi
authors.initials: V
authors.lastname: Kodumuri
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
authors.forename: Aziz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D004630:Emergencies; D017052:Hospital Mortality; D006801:Humans; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014481:United States