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UAlbany Study Compares Percutaneous Intervention Outcomes in Hospitals with and without Surgical Backup
A new study led by UAlbany Distinguished Professor Edward L. Hannan found little difference in patient outcomes for hospitals offering coronary angioplasty with and without surgical backup.
ALBANY, N.Y. (January 7, 2010) -- A recent study by University at Albany Distinguished Professor Edward L. Hannan and colleagues examined the relative effectiveness of percutaneous coronary interventions (PCI, also known as coronary angioplasty) for patients with a severe form of heart attack (known as ST-elevation myocardial infarction or STEMI) in two types of hospitals. The study, “Outcomes for Patient With ST-Elevation Myocardial Infarction in Hospitals With and Without Onsite Coronary Artery Bypass Graft Surgery,” was published in the December 2009 issue of Circulation: Cardiovascular Interventions. The study was conducted using data from the New York State Department of Health (NYSDOH), for whom Dr. Hannan serves as a consultant.
"The benefit of performing PCI for patients with STEMI is well documented. However, the benefit is partially based on how quickly patients undergo the procedure," said Hannan, who serves as associate dean for research at UAlbany’s School of Public Health. "Consequently it is desirable to have systems that enable performance of PCI within a short time frame after the onset of symptoms."
However, controversy exists as to whether PCIs should be expanded to facilities without coronary artery bypass graft surgery (CABG), something NYSDOH began to allow in a limited number of hospitals in 2000. This was accompanied by strict criteria governing the practice of primary (emergency) PCI (P-PCI) in these hospitals, including a thorough review of their data at 6- to 12-month intervals.
Hannan's study compared outcomes in two types of hospitals, full service (FS) centers that have backup coronary artery bypass graft (CABG) surgery for patients suffering complications of PCI, and primary PCI (P-PCI) centers with no backup CABG surgery capability. The latter type was created for the purpose of increasing the number of hospitals with emergency PCI capability to decrease average patient transport times.
The study found no differences between the hospital types for several outcomes: in-hospital/30-day mortality, emergency CABG surgery immediately after PCI, 3-year mortality, and 3-year subsequent PCI or CABG surgery. However, patients treated in P-PCI centers had a lower rate of same day or next day CABG surgery rate and a higher incidence of repeat target vessel PCI rates than patients treated at full service centers.
Also, for patients with STEMI who did not undergo PCI while in the hospital but received medical therapy, the study identified higher in-hospital mortality rates in P-PCI centers. The research concluded P-PCI centers should be monitored closely, including monitoring of patients with STEMI who do not undergo PCI after arrival at the hospital.
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