Percutaneous coronary intervention without onsite cardiac surgery.
BACKGROUND
Danish health authorities have major concerns with regard to the risk and the quality of care of percutaneous coronary intervention (PCI) without onsite cardiac surgery. We report the results of the first Danish PCI centre without onsite cardiac surgery.


METHODS
A total of 245 patients underwent 254 elective PCIs during a six-month study period. The outcome measures were treatment latency, health care costs, mortality rate, major adverse cardiovascular events, symptom relief and quality-of-life at six-month follow-up.


RESULTS
The median treatment latency was reduced from 28 to no days (p < 0.05) for patients with stable disease, and from seven to no days (p < 0.05) for patients with unstable disease. Health care costs were reduced by 4,246,652 DKK. The six-month mortality was 0.0% versus a predicted 0.4% New York State PCI-score in patients with stable disease, and a 1.4% observed study score versus a predicted 6.4% GRACE-score in patients with unstable disease. No patients required emergency bypass surgery. At six months, five myocardial infarctions (two periprocedural and two subacute stent thromboses), three restenoses and no in-stent restenosis had occurred, while angina was absent or reduced in 92% and quality-of-life had improved in 73% of the patients.


CONCLUSIONS
Local PCI without onsite cardiac surgery was safe, quality of care was increased, health care costs were reduced and patient-perceived treatment effect was excellent.
Department of Cardiology, Roskilde Hospital, Denmark.
Lars Lindholm
LL
Sørensen
Lars
L
Kjøller-Hansen
Gunnar Vagn Hagemann
GV
Jensen
Birgitte
B
Poulsen
Dorthe
D
Fisker
Steen
S
Carstensen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003718:Denmark; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000600:supply & distribution*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D018709:Statistics, Nonparametric; D013503:Surgery Department, Hospital / Q000600:supply & distribution*; D013997:Time Factors; D016896:Treatment Outcome