title: Outcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up.
  
  
  OBJECTIVE
  The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012.
  
  
  METHODS
  A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years.
  
  
  RESULTS
  Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p < 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients.
  
  
  CONCLUSIONS
  PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.
authors.affiliation: East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. Electronic address: scot.garg@elht.nhs.uk.
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.affiliation: Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: West of Scotland Regional Heart & Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Oldroyd
authors.affiliation: West of Scotland Regional Heart & Lung Center, Golden Jubilee National Hospital, Glasgow, United Kingdom; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom.
authors.forename: Connor A
authors.initials: CA
authors.lastname: Emdin
authors.affiliation: The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom.
authors.forename: Sanne A E
authors.initials: SA
authors.lastname: Peters
authors.affiliation: Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Nick E J
authors.initials: NE
authors.lastname: West
authors.affiliation: Derby Hospitals NHS Trust, Derby, United Kingdom.
authors.forename: Damian
authors.initials: D
authors.lastname: Kelly
authors.affiliation: East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom.
authors.forename: Kanarath
authors.initials: K
authors.lastname: Balachandran
authors.affiliation: East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: McDonald
authors.affiliation: East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom.
authors.forename: Ravi
authors.initials: R
authors.lastname: Singh
authors.affiliation: Royal Cornwall Hospitals Trust, Truro, United Kingdom.
authors.forename: Sen
authors.initials: S
authors.lastname: Devadathan
authors.affiliation: Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom.
authors.forename: Kazem
authors.initials: K
authors.lastname: Rahimi
authors.affiliation: The George Institute for Global Health, Nuffield Department of Population Health, Oxford Martin School, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D013531:Surgicenters; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: elective PCI; offsite surgical support; percutaneous coronary intervention; primary PCI