Outcomes for patients with ST-elevation myocardial infarction in hospitals with and without onsite coronary artery bypass graft surgery

The New York state experience

Edward L. Hannan, Ye Zhng, Michael Racz, Alice K. Jacobs, Gary D Walford, Kimberly Cozzens, David R. Holmes, Robert H. Jones, Mary Hibberd, Donna Doran, Deborah Whalen, Spencer B. King

Research output: Contribution to journalArticle

Abstract

Background - The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery. Methods and Results - Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared.For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [P=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%, P=0.06), 3-year mortality (7.1% versus 5.9%, P=0.07), or 3-year subsequent revascularization (23.8% versus 21.5%, P=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%, P=0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%, P=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75). Conclusions - No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.

Original languageEnglish (US)
Pages (from-to)519-527
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume2
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Mortality
Emergencies
ST Elevation Myocardial Infarction
Physiologic Monitoring
Hospital Mortality
Odds Ratio

Keywords

  • Mortality
  • Onsite coronary artery bypass graft (CABG)
  • Percutaneous coronary intervention (PCI)
  • STEMI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes for patients with ST-elevation myocardial infarction in hospitals with and without onsite coronary artery bypass graft surgery : The New York state experience. / Hannan, Edward L.; Zhng, Ye; Racz, Michael; Jacobs, Alice K.; Walford, Gary D; Cozzens, Kimberly; Holmes, David R.; Jones, Robert H.; Hibberd, Mary; Doran, Donna; Whalen, Deborah; King, Spencer B.

In: Circulation: Cardiovascular Interventions, Vol. 2, No. 6, 12.2009, p. 519-527.

Research output: Contribution to journalArticle

Hannan, Edward L. ; Zhng, Ye ; Racz, Michael ; Jacobs, Alice K. ; Walford, Gary D ; Cozzens, Kimberly ; Holmes, David R. ; Jones, Robert H. ; Hibberd, Mary ; Doran, Donna ; Whalen, Deborah ; King, Spencer B. / Outcomes for patients with ST-elevation myocardial infarction in hospitals with and without onsite coronary artery bypass graft surgery : The New York state experience. In: Circulation: Cardiovascular Interventions. 2009 ; Vol. 2, No. 6. pp. 519-527.
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abstract = "Background - The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery. Methods and Results - Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared.For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3{\%} for P-PCI centers versus 1.9{\%} for full service centers [P=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06{\%} versus 0.35{\%}, P=0.06), 3-year mortality (7.1{\%} versus 5.9{\%}, P=0.07), or 3-year subsequent revascularization (23.8{\%} versus 21.5{\%}, P=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23{\%} versus 0.69{\%}, P=0.046) and higher repeat target vessel PCI rates (12.1{\%} versus 9.0{\%}, P=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5{\%} versus 22.3{\%}; adjusted odds ratio, 1.38; 95{\%} CI, 1.10 to 1.75). Conclusions - No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.",
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T1 - Outcomes for patients with ST-elevation myocardial infarction in hospitals with and without onsite coronary artery bypass graft surgery

T2 - The New York state experience

AU - Hannan, Edward L.

AU - Zhng, Ye

AU - Racz, Michael

AU - Jacobs, Alice K.

AU - Walford, Gary D

AU - Cozzens, Kimberly

AU - Holmes, David R.

AU - Jones, Robert H.

AU - Hibberd, Mary

AU - Doran, Donna

AU - Whalen, Deborah

AU - King, Spencer B.

PY - 2009/12

Y1 - 2009/12

N2 - Background - The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery. Methods and Results - Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared.For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [P=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%, P=0.06), 3-year mortality (7.1% versus 5.9%, P=0.07), or 3-year subsequent revascularization (23.8% versus 21.5%, P=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%, P=0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%, P=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75). Conclusions - No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.

AB - Background - The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery. Methods and Results - Patients who were discharged after PCI for STEMI between January 1, 2003, and December 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared.For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [P=0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%, P=0.06), 3-year mortality (7.1% versus 5.9%, P=0.07), or 3-year subsequent revascularization (23.8% versus 21.5%, P=0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%, P=0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%, P=0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75). Conclusions - No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI.

KW - Mortality

KW - Onsite coronary artery bypass graft (CABG)

KW - Percutaneous coronary intervention (PCI)

KW - STEMI

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