title: Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup.
abstract: Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS).
  
  
  
  From August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210).
  
  
  
  There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: shokimot@kumamoto-u.ac.jp.
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sueta
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Tabata
authors.affiliation: Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Cardiovascular Center, Kumamoto Saiseikai Hospital, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakao
authors.affiliation: National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyao
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Hospital, Fukuoka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimomura
authors.affiliation: Kumamoto Red Cross Hospital, Kumamoto, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Tsunoda
authors.affiliation: Division of Cardiology, Minamata City Hospital and Medical Center, Minamata, Japan.
authors.forename: Toyoki
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Division of Cardiology, Arao City Hospital, Arao, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kajiwara
authors.affiliation: Division of Cardiology, Kumamoto Rosai Hospital, Yatsushiro, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: Division of Cardiology, Shin Beppu Hospital, Beppu, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Division of Cardiology, Health Insurance Yatsushiro General Hospital, Yatsushiro, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Koide
authors.affiliation: Division of Cardiology, Health Insurance Hitoyoshi General Hospital, Hitoyoshi, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Kumamoto City Hospital, Kumamoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Morikami
authors.affiliation: Division of Cardiology, Amakusa Regional Medical Center, Amakusa, Japan.
authors.forename: Naritsugu
authors.initials: N
authors.lastname: Sakaino
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.affiliation: Cardiovascular Center, New Tokyo Hospital, Matsudo, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D061846:Hospitals, Low-Volume; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D057216:Propensity Score; D012042:Registries; D020521:Stroke / Q000453:epidemiology
keywords: Acute coronary syndrome; Clinical outcomes; Hospital with or without onsite cardiac surgery back up; Percutaneous coronary intervention