Percutaneous coronary intervention at centers with and without on-site surgery: A meta-analysis

Mandeep Singh, David Holmes, Gregory J. Dehmer, Ryan J. Lennon, Thomas P. Wharton, Michael A. Kutcher, Thomas Aversano, Charanjit Rihal

Research output: Contribution to journalReview article

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Abstract

Context: Percutaneous coronary interventions are performed at centers without onsite surgery, despite current guidelines discouraging this. Objective: To assess literature comparing rates of in-hospital mortality and emergency coronary artery bypass grafting surgery at centers with and without on-site surgery. Data Sources: A systematic search of studies published between January 1990 and May 2010 was conducted using MEDLINE, EMBASE, and Cochrane Review databases. Study Selection: English-language studies of percutaneous coronary intervention performed at centers with and without on-site surgery providing data on in-hospital mortality and emergency bypass were identified. Two study authors independently reviewed the 1029 articles originally identified and selected 40 for analysis. Data Extraction: Study title, time period, indication for angioplasty, and outcomes were extracted manually from all selected studies, and quality of each study was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Data Synthesis: High-quality studies of percutaneous coronary interventions performed at centers with and without on-site surgery were included. Pooled-effect estimates were calculated with random-effects models. Analyses of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction of 124 074 patients demonstrated no increase in in-hospital mortality (no on-site surgery vs on-site surgery: observed risk, 4.6% vs 7.2%; odds ratio [OR], 0.96; 95% CI, 0.88-1.05; I 2 = 0%) or emergency bypass (observed risk, 0.22% vs 1.03%; OR, 0.53; 95% CI, 0.35-0.79; I 2 = 20%) at centers without on-site surgery. For nonprimary percutaneous coronary interventions (elective and urgent, n = 914 288), the rates of in-hospital mortality (observed risk, 1.4% vs 2.1%; OR, 1.15; 95% CI, 0.93-1.41; I 2 = 46%) and emergency bypass (observed risk, 0.17% vs 0.29%; OR, 1.21; 95% CI, 0.52-2.85; I 2 = 5%) were not significantly different at centers without or with on-site surgery. Conclusion: Percutaneous coronary interventions performed at centers without onsite surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery.

Original languageEnglish (US)
Pages (from-to)2487-2494
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume306
Issue number22
StatePublished - Dec 14 2011

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Percutaneous Coronary Intervention
Meta-Analysis
Hospital Mortality
Emergencies
Odds Ratio
Coronary Artery Bypass
Information Storage and Retrieval
Checklist
Angioplasty
MEDLINE
Observational Studies
Epidemiology
Language
Databases
Guidelines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Singh, M., Holmes, D., Dehmer, G. J., Lennon, R. J., Wharton, T. P., Kutcher, M. A., ... Rihal, C. (2011). Percutaneous coronary intervention at centers with and without on-site surgery: A meta-analysis. JAMA - Journal of the American Medical Association, 306(22), 2487-2494.

Percutaneous coronary intervention at centers with and without on-site surgery : A meta-analysis. / Singh, Mandeep; Holmes, David; Dehmer, Gregory J.; Lennon, Ryan J.; Wharton, Thomas P.; Kutcher, Michael A.; Aversano, Thomas; Rihal, Charanjit.

In: JAMA - Journal of the American Medical Association, Vol. 306, No. 22, 14.12.2011, p. 2487-2494.

Research output: Contribution to journalReview article

Singh, M, Holmes, D, Dehmer, GJ, Lennon, RJ, Wharton, TP, Kutcher, MA, Aversano, T & Rihal, C 2011, 'Percutaneous coronary intervention at centers with and without on-site surgery: A meta-analysis', JAMA - Journal of the American Medical Association, vol. 306, no. 22, pp. 2487-2494.
Singh, Mandeep ; Holmes, David ; Dehmer, Gregory J. ; Lennon, Ryan J. ; Wharton, Thomas P. ; Kutcher, Michael A. ; Aversano, Thomas ; Rihal, Charanjit. / Percutaneous coronary intervention at centers with and without on-site surgery : A meta-analysis. In: JAMA - Journal of the American Medical Association. 2011 ; Vol. 306, No. 22. pp. 2487-2494.
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abstract = "Context: Percutaneous coronary interventions are performed at centers without onsite surgery, despite current guidelines discouraging this. Objective: To assess literature comparing rates of in-hospital mortality and emergency coronary artery bypass grafting surgery at centers with and without on-site surgery. Data Sources: A systematic search of studies published between January 1990 and May 2010 was conducted using MEDLINE, EMBASE, and Cochrane Review databases. Study Selection: English-language studies of percutaneous coronary intervention performed at centers with and without on-site surgery providing data on in-hospital mortality and emergency bypass were identified. Two study authors independently reviewed the 1029 articles originally identified and selected 40 for analysis. Data Extraction: Study title, time period, indication for angioplasty, and outcomes were extracted manually from all selected studies, and quality of each study was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Data Synthesis: High-quality studies of percutaneous coronary interventions performed at centers with and without on-site surgery were included. Pooled-effect estimates were calculated with random-effects models. Analyses of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction of 124 074 patients demonstrated no increase in in-hospital mortality (no on-site surgery vs on-site surgery: observed risk, 4.6{\%} vs 7.2{\%}; odds ratio [OR], 0.96; 95{\%} CI, 0.88-1.05; I 2 = 0{\%}) or emergency bypass (observed risk, 0.22{\%} vs 1.03{\%}; OR, 0.53; 95{\%} CI, 0.35-0.79; I 2 = 20{\%}) at centers without on-site surgery. For nonprimary percutaneous coronary interventions (elective and urgent, n = 914 288), the rates of in-hospital mortality (observed risk, 1.4{\%} vs 2.1{\%}; OR, 1.15; 95{\%} CI, 0.93-1.41; I 2 = 46{\%}) and emergency bypass (observed risk, 0.17{\%} vs 0.29{\%}; OR, 1.21; 95{\%} CI, 0.52-2.85; I 2 = 5{\%}) were not significantly different at centers without or with on-site surgery. Conclusion: Percutaneous coronary interventions performed at centers without onsite surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery.",
author = "Mandeep Singh and David Holmes and Dehmer, {Gregory J.} and Lennon, {Ryan J.} and Wharton, {Thomas P.} and Kutcher, {Michael A.} and Thomas Aversano and Charanjit Rihal",
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T2 - A meta-analysis

AU - Singh, Mandeep

AU - Holmes, David

AU - Dehmer, Gregory J.

AU - Lennon, Ryan J.

AU - Wharton, Thomas P.

AU - Kutcher, Michael A.

AU - Aversano, Thomas

AU - Rihal, Charanjit

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N2 - Context: Percutaneous coronary interventions are performed at centers without onsite surgery, despite current guidelines discouraging this. Objective: To assess literature comparing rates of in-hospital mortality and emergency coronary artery bypass grafting surgery at centers with and without on-site surgery. Data Sources: A systematic search of studies published between January 1990 and May 2010 was conducted using MEDLINE, EMBASE, and Cochrane Review databases. Study Selection: English-language studies of percutaneous coronary intervention performed at centers with and without on-site surgery providing data on in-hospital mortality and emergency bypass were identified. Two study authors independently reviewed the 1029 articles originally identified and selected 40 for analysis. Data Extraction: Study title, time period, indication for angioplasty, and outcomes were extracted manually from all selected studies, and quality of each study was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Data Synthesis: High-quality studies of percutaneous coronary interventions performed at centers with and without on-site surgery were included. Pooled-effect estimates were calculated with random-effects models. Analyses of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction of 124 074 patients demonstrated no increase in in-hospital mortality (no on-site surgery vs on-site surgery: observed risk, 4.6% vs 7.2%; odds ratio [OR], 0.96; 95% CI, 0.88-1.05; I 2 = 0%) or emergency bypass (observed risk, 0.22% vs 1.03%; OR, 0.53; 95% CI, 0.35-0.79; I 2 = 20%) at centers without on-site surgery. For nonprimary percutaneous coronary interventions (elective and urgent, n = 914 288), the rates of in-hospital mortality (observed risk, 1.4% vs 2.1%; OR, 1.15; 95% CI, 0.93-1.41; I 2 = 46%) and emergency bypass (observed risk, 0.17% vs 0.29%; OR, 1.21; 95% CI, 0.52-2.85; I 2 = 5%) were not significantly different at centers without or with on-site surgery. Conclusion: Percutaneous coronary interventions performed at centers without onsite surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery.

AB - Context: Percutaneous coronary interventions are performed at centers without onsite surgery, despite current guidelines discouraging this. Objective: To assess literature comparing rates of in-hospital mortality and emergency coronary artery bypass grafting surgery at centers with and without on-site surgery. Data Sources: A systematic search of studies published between January 1990 and May 2010 was conducted using MEDLINE, EMBASE, and Cochrane Review databases. Study Selection: English-language studies of percutaneous coronary intervention performed at centers with and without on-site surgery providing data on in-hospital mortality and emergency bypass were identified. Two study authors independently reviewed the 1029 articles originally identified and selected 40 for analysis. Data Extraction: Study title, time period, indication for angioplasty, and outcomes were extracted manually from all selected studies, and quality of each study was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Data Synthesis: High-quality studies of percutaneous coronary interventions performed at centers with and without on-site surgery were included. Pooled-effect estimates were calculated with random-effects models. Analyses of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction of 124 074 patients demonstrated no increase in in-hospital mortality (no on-site surgery vs on-site surgery: observed risk, 4.6% vs 7.2%; odds ratio [OR], 0.96; 95% CI, 0.88-1.05; I 2 = 0%) or emergency bypass (observed risk, 0.22% vs 1.03%; OR, 0.53; 95% CI, 0.35-0.79; I 2 = 20%) at centers without on-site surgery. For nonprimary percutaneous coronary interventions (elective and urgent, n = 914 288), the rates of in-hospital mortality (observed risk, 1.4% vs 2.1%; OR, 1.15; 95% CI, 0.93-1.41; I 2 = 46%) and emergency bypass (observed risk, 0.17% vs 0.29%; OR, 1.21; 95% CI, 0.52-2.85; I 2 = 5%) were not significantly different at centers without or with on-site surgery. Conclusion: Percutaneous coronary interventions performed at centers without onsite surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery.

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