title: Rationale and design of the MASS COMM trial: A randomized trial to compare percutaneous coronary intervention between MASSachusetts hospitals with cardiac surgery on-site and COMMunity hospitals without cardiac surgery on-site.
abstract: BACKGROUND
  Emergency surgery has become an increasingly rare event after percutaneous coronary intervention (PCI). There have been no randomized trials evaluating whether cardiac surgery services on-site are essential for patient safety and optimal outcomes during and after PCI.
  
  
  METHODS
  The MASS COMM trial (ClinicalTrials.gov no. NCT01116882) is a randomized trial comparing the safety and effectiveness of nonemergency PCI at hospitals without surgery on-site (SOS) (non-SOS hospitals) and hospitals with SOS (SOS hospitals). A total of 3,690 subjects will be randomized in a 3:1 fashion to undergo PCI at non-SOS and SOS hospitals, with follow-up at hospital discharge, 30 days, and 12 months after PCI. The rate of major adverse cardiac events (all-cause mortality, myocardial infarction, repeat revascularization, and stroke) will serve as the primary safety end point at 30 days and the primary effectiveness end point at 12 months. The design is a 1-way randomized trial with a statistical hypothesis of noninferiority of nonemergency PCI at non-SOS hospitals for both safety and effectiveness end points.
  
  
  CONCLUSIONS
  This multicenter, randomized trial will compare the relative safety and effectiveness of nonemergency PCI at sites with and without cardiac SOS.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. lmauri1@partners.org
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Michael
authors.initials: M
authors.lastname: Pencina
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.forename: Cathy
authors.initials: C
authors.lastname: Jeon
authors.forename: Paul
authors.initials: P
authors.lastname: Dreyer
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kuntz
authors.forename: Donald S
authors.initials: DS
authors.lastname: Baim
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts; D018579:Patient Selection; D012107:Research Design; D016896:Treatment Outcome