Outcomes of percutaneous coronary intervention performed at offsite versus onsite surgical centers in the United Kingdom

Scot Garg, Simon G. Anderson, Keith Oldroyd, Colin Berry, Connor A. Emdin, Sanne A.E. Peters, Nick E.J. West, Damian Kelly, Kanarath Balachandran, John McDonald, Ravi Singh, Sen Devadathan, Simon Redwood, Peter F. Ludman, Kazem Rahimi, Mark Woodward

Research output: Contribution to journalArticlepeer-review

Abstract

Background Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. Objectives The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. Methods A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. Results Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p < 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients. Conclusions PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.

Original languageEnglish (US)
Pages (from-to)363-372
Number of pages10
JournalJournal of the American College of Cardiology
Volume66
Issue number4
DOIs
StatePublished - Jul 28 2015

Keywords

  • elective PCI
  • offsite surgical support
  • percutaneous coronary intervention
  • primary PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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