Patients who had nonemergency angioplasty or stent implantation at experienced hospitals without on-site heart surgery capabilities fared no worse than those in surgery-equipped hospitals, according to a new study.

Researchers at Johns Hopkins Medical Institutions (Baltimore, MD, USA) randomly assigned 13,995 patients participating in the Cardiovascular Patient Outcomes Research Team (CPORT) study to have their percutaneous coronary intervention (PCI) done at a hospital with cardiac surgery capabilities, and 4,523 patients at hospitals without; if emergency surgery was required at a hospital without on-site surgery, the patient was transferred urgently. The 60 hospitals selected without cardiac surgery capabilities had to be able to perform annually at least 200 PCIs, and the physicians doing the procedures were required to be performing more than 75 PCI cases annually.

The results showed that the mortality rate after six weeks was almost the same for each group, at less than one percent. Furthermore, emergency surgery was only 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 where surgery was available. The study was presented at the American Heart Association (AHA) Scientific Sessions, held during November 2011 in Orlando (FL, USA).

“In the 1980s, the need for cardiac surgery was high; 5% to 7% of these cases could require emergency open heart or bypass surgery. The cardiac operating room was kept open in the event a complication requiring surgery occurred,” said lead author interventional cardiologist Thomas Aversano, MD. “Now it's 1 in 500 or 1 in 1,000; it's very uncommon.”

“We do not support the spread of angioplasty to every hospital in the United States. However, it can be burdensome and costly for all medical centers to have cardiac surgery capabilities,” added Dr. Aversano. “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.”
 

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