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EXPEDITED REVIEW

A Total of 1,007 Percutaneous Coronary Interventions Without Onsite Cardiac Surgery

Acute and Long-Term Outcomes

Henry H. Ting, MD, MBA, FACC^_*,_*, Ganesh Raveendran, MD^_*, Ryan J. Lennon, MS, Kirsten Hall Long, PhD, Mandeep Singh, MBBS, FACC^_*, Douglas L. Wood, MD, FACC^_*, Bernard J. Gersh, MB, ChB, DPhil, FACC^_*, Charanjit S. Rihal, MD, MBA, FACC^_* and David R. Holmes, Jr, MD, FACC^_*

^_* Division of Cardiovascular Diseases
Department of Health Sciences Research, Division of Biostatistics
Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota

Manuscript received January 3, 2006; revised manuscript received January 31, 2006, accepted February 17, 2006.

^_* Reprint requests and correspondence: Dr. Henry H. Ting, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (Email: ting.henry{at}mayo.edu).

OBJECTIVES: We sought to compare clinical outcomes of elective percutaneous coronary intervention (PCI) and primary PCI for ST-segment elevation myocardial infarction (STEMI) at a community hospital without onsite cardiac surgery to those at a tertiary center with onsite cardiac surgery.

BACKGROUND: Disagreement exists about whether hospitals with cardiac catheterization laboratories, but without onsite cardiac surgery, should develop PCI programs. Primary PCI for STEMI at hospitals without onsite cardiac surgery have achieved satisfactory outcomes; however, elective PCI outcomes are not well defined.

METHODS: A total of 1,007 elective PCI and primary PCI procedures performed from March 1999 to August 2005 at the Immanuel St. Joseph's Hospital–Mayo Health System (ISJ) in Mankato, Minnesota, were matched one-to-one with those performed at St. Mary's Hospital (SMH) in Rochester, Minnesota. Strict protocols were followed for case selection and PCI program requirements. Clinical outcomes (in-hospital procedural success, death, any myocardial infarction, Q-wave myocardial infarction, and emergency coronary artery bypass surgery) and follow-up survival were compared between groups.

RESULTS: Among 722 elective PCIs, procedural success was 97% at ISJ compared with 95% at SMH (p = 0.046). Among 285 primary PCIs for STEMI, procedural success was 93% at ISJ and 96% at SMH (p = 0.085). No patients at ISJ undergoing PCI required emergent transfer for cardiac surgery. Survival at two years' follow-up by treatment location was similar for patients with elective PCI and primary PCI.

CONCLUSIONS: Similar clinical outcomes for elective PCI and primary PCI were achieved at a community hospital without onsite cardiac surgery compared with those at a tertiary center with onsite cardiac surgery using a prospective, rigorous protocol for case selection and PCI program requirements.

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   CABG = coronary artery bypass surgery   CI = confidence interval   ISJ = Immanuel St. Joseph's Hospital–Mayo Health System   MI = myocardial infarction   PCI = percutaneous coronary intervention   SMH = St. Mary's Hospital   STEMI = ST-segment elevation myocardial infarction   TVR = target vessel revascularization

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