title: Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies.
abstract: BACKGROUND
  Emergency coronary artery bypass grafting for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and nonprimary PCI at centers with and without on-site surgical backup.
  
  
  RESULTS
  We performed an updated systematic review and meta-analysis by using mixed-effects models. We included 23 high-quality studies that compared clinical outcomes and complication rates of 1 101 123 patients after PCI at centers with or without on-site surgery. For primary PCI for ST-segment-elevation myocardial infarction (133 574 patients), all-cause mortality (without on-site surgery versus with on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR], 0.99; 95% confidence interval, 0.91-1.07; P=0.729; I(2)=3.4%) or emergency coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%; pooled OR, 0.76; 95% confidence interval, 0.56-1.01; P=0.062; I(2)=42.5%) did not differ by presence of on-site surgery. For nonprimary PCI (967 549 patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled OR, 1.15; 95% confidence interval, 0.94-1.41; P=0.172; I(2)=67.5%) and emergency coronary artery bypass grafting rates (observed rates, 0.5% versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62-2.13; P=0.669; I(2)=81.7%) were not significantly different. PCI complication rates (cardiogenic shock, stroke, aortic dissection, tamponade, recurrent infarction) also did not differ by on-site surgical capability. Cumulative meta-analysis of nonprimary PCI showed a temporal decrease of the effect size (OR) for all-cause mortality after 2007.
  
  
  CONCLUSIONS
  Clinical outcomes and complication rates of PCI at centers without on-site surgery did not differ from those with on-site surgery, for both primary and nonprimary PCI. Temporal trends indicated improving clinical outcomes in nonprimary PCI at centers without on-site surgery.
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
authors.forename: Joo Myung
authors.initials: JM
authors.lastname: Lee
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
authors.forename: Doyeon
authors.initials: D
authors.lastname: Hwang
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
authors.forename: Jonghanne
authors.initials: J
authors.lastname: Park
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
authors.forename: Kyung-Jin
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.). bkkoo@snu.ac.kr.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D013531:Surgicenters / Q000706:statistics & numerical data*; D015996:Survival Rate; D013903:Thoracic Surgery / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
keywords: STEMI; meta-analysis; mortality; onsite coronary artery bypass graft (CABG); outcome assessment (health care); percutaneous coronary intervention; thoracic surgery