Abstract 4499: Outcomes Following Primary Percutaneous Coronary Intervention: A Comparison Between Hospitals With and Without Cardiac Surgery On-Site
Background: To increase the number of ST-elevation myocardial infarction (STEMI) patients with timely access to primary percutaneous coronary intervention (PCI), the Massachusetts Department of Health approved a pilot program for primary PCI at hospitals without cardiac surgery on-site (No SOS). To participate, No SOS hospitals were required to meet ACC/AHA guideline recommendations for hospital and operator volume of procedures. To determine the safety and efficacy of this strategy, we compared outcomes at 30 days and one-year between patients undergoing primary PCI at No SOS and SOS hospitals.
Methods: We used the prospectively collected data in the Massachusetts Data Analysis Center, the state mandated and audited PCI registry, to evaluate 6680 STEMI patients undergoing primary PCI at No SOS (n=858) and SOS (n=5814) hospitals between 4/1/03 and 9/30/06. Risk-adjusted all-cause mortality, myocardial infarction (MI), repeat revascularization (RR) and target vessel revascularization (TVR) were determined with propensity-score matching (2:1) for STEMI patients treated at SOS and No SOS hospitals based on clinical, angiographic, and procedural information.
Results: After matching, no significant difference between patients treated at No SOS and SOS hospitals in baseline characteristics including age, sex, prevalence of diabetes mellitus, hypertension, CHF, peripheral vascular disease, renal failure, prior PCI or CABG, prior MI, symptom duration, shock, number of diseased vessels or treated lesions, or target vessel was found. Risk adjusted outcomes (expressed as absolute risk difference with 95% confidence intervals (CI)) are shown in Table 1⇓.
Conclusion: Performance of primary PCI at No SOS compared to SOS hospitals in Massachusetts results in similar mortality and TVR at one-year. Whether the higher rate of RR represents staged procedures in patients with multi-vessel disease and the apparent higher risk of MI will require further study.