Percutaneous Coronary Intervention at Centers With and Without On-Site Surgical Backup: An Updated Meta-Analysis of 23 Studies
Background—Emergency coronary artery bypass grafting (CABG) for unsuccessful percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate the current safety and outcomes of primary PCI and non-primary PCI at centers with and without on-site surgical backup.
Methods and Results—We performed an updated systematic review and meta-analysis 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 vs. with on-site surgery: observed rates, 4.8% vs. 7.2%, pooled OR 0.99, 95% CI 0.91-1.07, p=0.729, I2=3.4%) or emergency CABG rates (observed rates, 1.5% vs. 2.4%, pooled OR 0.76, 95% CI 0.56-1.01, p=0.062, I2=42.5%) did not differ by presence of on-site surgery. For non-primary PCI (967,549 patients), all-cause mortality (observed rates, 1.6% vs. 2.1%, pooled OR 1.15, 95% CI 0.94-1.41, p=0.172, I2=67.5%) and emergency CABG rates (observed rates, 0.5% vs. 0.8%, pooled OR 1.14, 95% CI 0.62-2.13, p=0.669, I2=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 non-primary 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 non-primary PCI. Temporal trends indicated improving clinical outcomes in non-primary PCI at centers without on-site surgery.
- percutaneous coronary intervention
- outcome and process assessment
- on-site coronary artery bypass graft surgery
- Received February 20, 2015.
- Revision received May 30, 2015.
- Accepted June 3, 2015.