title: Percutaneous coronary intervention with vs without on-site cardiac surgery backup: a systematic review and meta-analysis.
abstract: Although the popularity of performing percutaneous coronary intervention (PCI) in centres without on-site cardiac surgery backup is increasing, the safety of this practice is unknown. Our goal was to perform a systematic review and meta-analysis of PCI with and without on-site cardiac surgery backup. We identified studies using computerized literature searches through July 2009. Main outcomes of interest included in-hospital mortality and early coronary artery bypass grafting (CABG). Analyses were stratified by procedure indication (primary PCI and nonprimary PCI). Pooled estimates were obtained using random-effects models. We identified 9 primary PCI studies (106,089 patients) and 7 nonprimary studies (910,422 patients) comparing centres with and without on-site cardiac surgery. For primary PCI, centres without on-site surgery had no significantly increased risk of in-hospital mortality (odds ratio [OR] 0.93; 95% confidence interval [CI], 0.83-1.05) or early CABG (OR 0.87; 95% CI, 0.68-1.11) compared with centres with on-site surgery. For nonprimary PCI, no increased risk of in-hospital mortality (OR 1.03; 95% CI, 0.64-1.66) and early CABG (OR 1.38; 95% CI, 0.65-2.95) was observed in centres without backup. However, significant heterogeneity existed in estimates of nonprimary PCI studies, suggesting substantial variation in outcomes of nonprimary PCI across centres without on-site cardiac surgery. We demonstrated that rates of in-hospital mortality and early CABG were similar at PCI centres with and without on-site cardiac surgery backup. However, variations in outcomes suggest that assurance of optimal outcomes at each PCI centre without on-site surgery is needed.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: Zia
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
mesh_terms: D006801:Humans; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000401:mortality; D017052:Hospital Mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D013503:Surgery Department, Hospital