01:30pm Friday 22 September 2017

Elective angioplasty patients can fare well in experienced hospitals with no heart surgery capabilities

ORLANDO, FLA. ― Patients who had non-emergency artery-opening angioplasty or stent implantation at experienced hospitals without on-site heart surgery capabilities fared no worse than those in surgery-equipped hospitals, according to late-breaking research presented at the American Heart Association’s Scientific Sessions 2011.
      In a study from the Cardiovascular Patient Outcomes Research Team (CPORT), researchers randomly assigned 13,995 patients to have their procedure done at a hospital with cardiac surgery capabilities and 4,523 patients at hospitals without.
 
      The death rate after six weeks was almost the same for each group ― just under 1 percent, researchers said.  Furthermore, neither group were more likely to need emergency heart bypass surgery.
 
If emergency surgery was required at a hospital without on-site surgery, the patient was transferred urgently.
 
The American College of Cardiology Foundation/American Heart Association guidelines have recommended that elective angioplasty and stent implantation be done at hospitals with cardiac surgery facilities in the same building in case emergency surgery is needed.
 
In this study, emergency surgery was needed for 20 of the 13,995 patients undergoing procedures at hospitals without on-site surgery and 10 of the 4,523 patients treated at hospitals with surgery available.
 
      However, the need for emergency surgery during these procedures has plummeted over the last few decades, said Thomas Aversano, M.D., the study’s lead researcher and associate professor of medicine at Johns Hopkins Medical Institutions in Baltimore, Md.
 
“In the 1980s, the need for cardiac surgery was high; 5 percent to 7 percent of these cases could require emergency open heart or bypass surgery,” Aversano said. “The cardiac operating room was kept open in the event a complication requiring surgery occurred. Now it’s one in 500 or one in 1,000. It’s very uncommon.”
 
      In this carefully structured study, the 60 hospitals without cardiac surgery capabilities had to be able to annually perform at least 200 angioplasties or stent implantations, also called percutaneous coronary interventions or PCI. The physicians doing the procedures were required to be performing more than 75 PCI cases annually. All centers underwent a formally developed PCI program.
 
      Some states restrict hospitals from performing these procedures without on-site surgery, except for an emergency, Aversano said.
 
“We do not support the spread of angioplasty to every hospital in the United States,” he said. “However, it can be burdensome and costly for all medical centers to have cardiac surgery capabilities. And it doesn’t make sense to create more surgical programs just to support the angioplasty programs.”
 
He said regional healthcare planners can use the data from the study to make informed decisions about which hospitals should have PCI capability, with the aim of improving quality, improving access and lowering costs.
 
The study provides only short-term results, but early next year, researchers will have data revealing how patients fared nine months after the procedure. They said this will be important in assessing the overall effect of these two systems of care on ultimate patient outcomes.
 
Co-authors are the C-PORT investigators.
The participating medical centers funded the study.
 
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Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding External link.
 
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