NDLI: Outcomes of PCI at hospitals with or without on-site cardiac surgery.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Aversano, Thomas Lemmon, Cynthia C. Liu, Li
Spatial Coverage	United States
Description	Author Affiliation: Aversano T ( Johns Hopkins University, Baltimore, MD, USA. taversan@jhmi.edu)
Abstract	BACKGROUND: Performance of percutaneous coronary intervention (PCI) is usually restricted to hospitals with cardiac surgery on site. We conducted a noninferiority trial to compare the outcomes of PCI performed at hospitals without and those with on-site cardiac surgery. METHODS: We randomly assigned participants to undergo PCI at a hospital with or without on-site cardiac surgery. Patients requiring primary PCI were excluded. The trial had two primary end points: 6-week mortality and 9-month incidence of major adverse cardiac events (the composite of death, Q-wave myocardial infarction, or target-vessel revascularization). Noninferiority margins for the risk difference were 0.4 percentage points for mortality at 6 weeks and 1.8 percentage points for major adverse cardiac events at 9 months. RESULTS: A total of 18,867 patients were randomly assigned in a 3:1 ratio to undergo PCI at a hospital without on-site cardiac surgery (14,149 patients) or with on-site cardiac surgery (4718 patients). The 6-week mortality rate was 0.9% at hospitals without on-site surgery versus 1.0% at those with on-site surgery (difference, -0.04 percentage points; 95% confidence interval [CI], -0.31 to 0.23; P=0.004 for noninferiority). The 9-month rates of major adverse cardiac events were 12.1% and 11.2% at hospitals without and those with on-site surgery, respectively (difference, 0.92 percentage points; 95% CI, 0.04 to 1.80; P=0.05 for noninferiority). The rate of target-vessel revascularization was higher in hospitals without on-site surgery (6.5% vs. 5.4%, P=0.01). CONCLUSIONS: We found that PCI performed at hospitals without on-site cardiac surgery was noninferior to PCI performed at hospitals with on-site cardiac surgery with respect to mortality at 6 weeks and major adverse cardiac events at 9 months. (Funded by the Cardiovascular Patient Outcomes Research Team [C-PORT] participating sites; ClinicalTrials.gov number, NCT00549796.).
ISSN	00284793
Issue Number	19
Volume Number	366
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2012-05-10
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Angioplasty, Balloon, Coronary Cardiology Service, Hospital Myocardial Infarction Therapy Aged Adverse Effects Coronary Artery Bypass Emergency Treatment Female Humans Male Middle Aged Mortality Retreatment Treatment Outcome United States Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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