Abstract 14900: Clinical Outcomes of Elective Percutaneous Coronary Intervention (PCI) for Stable Angina at Hospital With or Without Onsite Cardiac Surgery Backup
Background: Based on 2011 ACCF/AHA/SCAI PCI guidelines, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent foreign data suggests that there is no significant difference in clinical outcomes following primary and elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following elective PCI for stable angina.
Methods: From Aug 2008 to March 2011, subjects (n=3931) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=3455) or without (n=476) 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 non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG.
Results: There was no overall significant difference in the primary endpoint between hospitals with and without onsite cardiac surgery (2.1%vs2.7%; P=0.363). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite surgery (15.0%vs9.5%; P=0.001). Kaplan-Meier analysis for the primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.419). By cox hazards model analysis for the primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 1.275, 95%CI 0.706-2.302; P=0.420). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (1.8% vs 2.7%; P=0.315).
Conclusions: The overall cardiovascular event following elective PCI for stable angina is not statistically difference in hospitals with or without onsite cardiac surgery.
Author Disclosures: T. Akasaka: None. S. Hokimoto: None. N. Tabata: None. K. Sakamoto: None. K. Tsujita: None. S. Kojima: None. K. Kaikita: None. H. Ogawa: Other Research Support; Modest; Astra Zeneca, Astellas, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Novartis, Pfizer, Sanofi, Takeda. Other Research Support; Significant; Bayer, Chugai, Otsuka. Honoraria; Modest; Astra Zeneca, Bayer, Pfizer, Sanofi, Takeda. Honoraria; Significant; Daiichi Sankyo, MSD.
- © 2014 by American Heart Association, Inc.