Outcomes and temporal trends of inpatient percutaneous coronary intervention at centers with and without on-site cardiac surgery in the United States

Kashish Goel, Tanush Gupta, Dhaval Kolte, Sahil Khera, Gregg C. Fonarow, Deepak L. Bhatt, Mandeep Singh, Charanjit S. Rihal

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE: There are concerns whether percutaneous coronary intervention (PCI) at centers without on-site cardiac surgery is safe outside of a tightly regulated research environment. OBJECTIVE: To analyze the outcomes and temporal trends of inpatient PCI at centers without on-site cardiac surgery in an unselected and nationally representative population of the United States. DESIGN, SETTING, AND PARTICIPANTS: A national inpatient sample (N = 6 912 232) was used to identify patients who underwent inpatient PCI in the United States from January 1, 2003, to December 31, 2012. Hospitals that performed 1 or more coronary artery bypass graft surgeries in a given calendar year were classified as centers with on-site cardiac surgery, and weighted sampling of all inpatient hospitalizations was performed. Data analysis was performed from February to May 2016. EXPOSURES: Inpatient PCI. MAIN OUTCOMES AND MEASURES: In-hospital mortality. RESULTS: Of the 6 912 232 inpatient PCIs performed, 2 336 334 patients (33.8%) were women and 4 575 898 (66.2%) were men; their mean (SD) age was 64.5 (12.3) years. Of these PCIs, 396 741 (5.7%) were conducted at centers without on-site cardiac surgery. The rate of in-hospital mortality was significantly lower at centers with on-site cardiac surgery compared with centers without on-site cardiac surgery (1.4% vs 1.9%; unadjusted odds ratio [OR], 0.74; 95% CI, 0.72-0.75). After adjustment, there was no significant difference in in-hospital mortality between centers with and without on-site cardiac surgery (OR, 1.01; 95% CI, 0.98-1.03; P = .62) for acute coronary syndromes and elective procedures requiring inpatient hospitalization. In addition, there were no significant differences in the risk-adjusted, in-hospital mortality between the 2 groups in prespecified subgroups after adjusting for multiple comparisons, including ST-elevation myocardial infarction (OR, 0.99; 95% CI, 0.96-1.03; P = .65), non-ST-elevation acute coronary syndrome (OR, 0.99; 95% CI, 0.93-1.05; P = .66), and elective PCI (OR, 0.93; 95% CI, 0.84-1.03; P = .17). There was a significant increase in the proportion of PCIs at centers without on-site cardiac surgery within the study period (from 1.8% to 12.7%; P < .001 for trend by Cochrane-Armitage test) reflected across all the indications. CONCLUSIONS AND RELEVANCE: There was a 7-fold increase in the proportion of PCIs at centers without on-site cardiac surgery from 2003 to 2012 in the United States, with the adjusted in-hospital mortality after inpatient PCI being similar at centers with and without on-site cardiac surgery. These data provide evidence that PCI at centers without on-site cardiac surgery may be safe in the modern era.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalJAMA Cardiology
Volume2
Issue number1
DOIs
StatePublished - Jan 1 2017

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Percutaneous Coronary Intervention
Thoracic Surgery
Inpatients
Hospital Mortality
Odds Ratio
Acute Coronary Syndrome
Hospitalization
Coronary Artery Bypass
Outcome Assessment (Health Care)
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Outcomes and temporal trends of inpatient percutaneous coronary intervention at centers with and without on-site cardiac surgery in the United States. / Goel, Kashish; Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Fonarow, Gregg C.; Bhatt, Deepak L.; Singh, Mandeep; Rihal, Charanjit S.

In: JAMA Cardiology, Vol. 2, No. 1, 01.01.2017, p. 25-33.

Research output: Contribution to journalArticle

Goel, Kashish ; Gupta, Tanush ; Kolte, Dhaval ; Khera, Sahil ; Fonarow, Gregg C. ; Bhatt, Deepak L. ; Singh, Mandeep ; Rihal, Charanjit S. / Outcomes and temporal trends of inpatient percutaneous coronary intervention at centers with and without on-site cardiac surgery in the United States. In: JAMA Cardiology. 2017 ; Vol. 2, No. 1. pp. 25-33.
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abstract = "IMPORTANCE: There are concerns whether percutaneous coronary intervention (PCI) at centers without on-site cardiac surgery is safe outside of a tightly regulated research environment. OBJECTIVE: To analyze the outcomes and temporal trends of inpatient PCI at centers without on-site cardiac surgery in an unselected and nationally representative population of the United States. DESIGN, SETTING, AND PARTICIPANTS: A national inpatient sample (N = 6 912 232) was used to identify patients who underwent inpatient PCI in the United States from January 1, 2003, to December 31, 2012. Hospitals that performed 1 or more coronary artery bypass graft surgeries in a given calendar year were classified as centers with on-site cardiac surgery, and weighted sampling of all inpatient hospitalizations was performed. Data analysis was performed from February to May 2016. EXPOSURES: Inpatient PCI. MAIN OUTCOMES AND MEASURES: In-hospital mortality. RESULTS: Of the 6 912 232 inpatient PCIs performed, 2 336 334 patients (33.8{\%}) were women and 4 575 898 (66.2{\%}) were men; their mean (SD) age was 64.5 (12.3) years. Of these PCIs, 396 741 (5.7{\%}) were conducted at centers without on-site cardiac surgery. The rate of in-hospital mortality was significantly lower at centers with on-site cardiac surgery compared with centers without on-site cardiac surgery (1.4{\%} vs 1.9{\%}; unadjusted odds ratio [OR], 0.74; 95{\%} CI, 0.72-0.75). After adjustment, there was no significant difference in in-hospital mortality between centers with and without on-site cardiac surgery (OR, 1.01; 95{\%} CI, 0.98-1.03; P = .62) for acute coronary syndromes and elective procedures requiring inpatient hospitalization. In addition, there were no significant differences in the risk-adjusted, in-hospital mortality between the 2 groups in prespecified subgroups after adjusting for multiple comparisons, including ST-elevation myocardial infarction (OR, 0.99; 95{\%} CI, 0.96-1.03; P = .65), non-ST-elevation acute coronary syndrome (OR, 0.99; 95{\%} CI, 0.93-1.05; P = .66), and elective PCI (OR, 0.93; 95{\%} CI, 0.84-1.03; P = .17). There was a significant increase in the proportion of PCIs at centers without on-site cardiac surgery within the study period (from 1.8{\%} to 12.7{\%}; P < .001 for trend by Cochrane-Armitage test) reflected across all the indications. CONCLUSIONS AND RELEVANCE: There was a 7-fold increase in the proportion of PCIs at centers without on-site cardiac surgery from 2003 to 2012 in the United States, with the adjusted in-hospital mortality after inpatient PCI being similar at centers with and without on-site cardiac surgery. These data provide evidence that PCI at centers without on-site cardiac surgery may be safe in the modern era.",
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T1 - Outcomes and temporal trends of inpatient percutaneous coronary intervention at centers with and without on-site cardiac surgery in the United States

AU - Goel, Kashish

AU - Gupta, Tanush

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Fonarow, Gregg C.

AU - Bhatt, Deepak L.

AU - Singh, Mandeep

AU - Rihal, Charanjit S.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - IMPORTANCE: There are concerns whether percutaneous coronary intervention (PCI) at centers without on-site cardiac surgery is safe outside of a tightly regulated research environment. OBJECTIVE: To analyze the outcomes and temporal trends of inpatient PCI at centers without on-site cardiac surgery in an unselected and nationally representative population of the United States. DESIGN, SETTING, AND PARTICIPANTS: A national inpatient sample (N = 6 912 232) was used to identify patients who underwent inpatient PCI in the United States from January 1, 2003, to December 31, 2012. Hospitals that performed 1 or more coronary artery bypass graft surgeries in a given calendar year were classified as centers with on-site cardiac surgery, and weighted sampling of all inpatient hospitalizations was performed. Data analysis was performed from February to May 2016. EXPOSURES: Inpatient PCI. MAIN OUTCOMES AND MEASURES: In-hospital mortality. RESULTS: Of the 6 912 232 inpatient PCIs performed, 2 336 334 patients (33.8%) were women and 4 575 898 (66.2%) were men; their mean (SD) age was 64.5 (12.3) years. Of these PCIs, 396 741 (5.7%) were conducted at centers without on-site cardiac surgery. The rate of in-hospital mortality was significantly lower at centers with on-site cardiac surgery compared with centers without on-site cardiac surgery (1.4% vs 1.9%; unadjusted odds ratio [OR], 0.74; 95% CI, 0.72-0.75). After adjustment, there was no significant difference in in-hospital mortality between centers with and without on-site cardiac surgery (OR, 1.01; 95% CI, 0.98-1.03; P = .62) for acute coronary syndromes and elective procedures requiring inpatient hospitalization. In addition, there were no significant differences in the risk-adjusted, in-hospital mortality between the 2 groups in prespecified subgroups after adjusting for multiple comparisons, including ST-elevation myocardial infarction (OR, 0.99; 95% CI, 0.96-1.03; P = .65), non-ST-elevation acute coronary syndrome (OR, 0.99; 95% CI, 0.93-1.05; P = .66), and elective PCI (OR, 0.93; 95% CI, 0.84-1.03; P = .17). There was a significant increase in the proportion of PCIs at centers without on-site cardiac surgery within the study period (from 1.8% to 12.7%; P < .001 for trend by Cochrane-Armitage test) reflected across all the indications. CONCLUSIONS AND RELEVANCE: There was a 7-fold increase in the proportion of PCIs at centers without on-site cardiac surgery from 2003 to 2012 in the United States, with the adjusted in-hospital mortality after inpatient PCI being similar at centers with and without on-site cardiac surgery. These data provide evidence that PCI at centers without on-site cardiac surgery may be safe in the modern era.

AB - IMPORTANCE: There are concerns whether percutaneous coronary intervention (PCI) at centers without on-site cardiac surgery is safe outside of a tightly regulated research environment. OBJECTIVE: To analyze the outcomes and temporal trends of inpatient PCI at centers without on-site cardiac surgery in an unselected and nationally representative population of the United States. DESIGN, SETTING, AND PARTICIPANTS: A national inpatient sample (N = 6 912 232) was used to identify patients who underwent inpatient PCI in the United States from January 1, 2003, to December 31, 2012. Hospitals that performed 1 or more coronary artery bypass graft surgeries in a given calendar year were classified as centers with on-site cardiac surgery, and weighted sampling of all inpatient hospitalizations was performed. Data analysis was performed from February to May 2016. EXPOSURES: Inpatient PCI. MAIN OUTCOMES AND MEASURES: In-hospital mortality. RESULTS: Of the 6 912 232 inpatient PCIs performed, 2 336 334 patients (33.8%) were women and 4 575 898 (66.2%) were men; their mean (SD) age was 64.5 (12.3) years. Of these PCIs, 396 741 (5.7%) were conducted at centers without on-site cardiac surgery. The rate of in-hospital mortality was significantly lower at centers with on-site cardiac surgery compared with centers without on-site cardiac surgery (1.4% vs 1.9%; unadjusted odds ratio [OR], 0.74; 95% CI, 0.72-0.75). After adjustment, there was no significant difference in in-hospital mortality between centers with and without on-site cardiac surgery (OR, 1.01; 95% CI, 0.98-1.03; P = .62) for acute coronary syndromes and elective procedures requiring inpatient hospitalization. In addition, there were no significant differences in the risk-adjusted, in-hospital mortality between the 2 groups in prespecified subgroups after adjusting for multiple comparisons, including ST-elevation myocardial infarction (OR, 0.99; 95% CI, 0.96-1.03; P = .65), non-ST-elevation acute coronary syndrome (OR, 0.99; 95% CI, 0.93-1.05; P = .66), and elective PCI (OR, 0.93; 95% CI, 0.84-1.03; P = .17). There was a significant increase in the proportion of PCIs at centers without on-site cardiac surgery within the study period (from 1.8% to 12.7%; P < .001 for trend by Cochrane-Armitage test) reflected across all the indications. CONCLUSIONS AND RELEVANCE: There was a 7-fold increase in the proportion of PCIs at centers without on-site cardiac surgery from 2003 to 2012 in the United States, with the adjusted in-hospital mortality after inpatient PCI being similar at centers with and without on-site cardiac surgery. These data provide evidence that PCI at centers without on-site cardiac surgery may be safe in the modern era.

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