Introduction: Primary percutaneous coronary intervention (PPCI) is increasingly performed nationally at sites without on-site cardiac surgery; however, recent guidelines only provide a Class IIa recommendation for this practice. The State of Michigan has permitted PPCI without surgical back up under a closely monitored system that mandates auditing of all procedures and quarterly feedback on quality and outcomes. This study sought to compare outcomes of patients undergoing PPCI at centers with and without on-site surgery in the state of Michigan.
Hypothesis: We assessed the hypothesis that there would be no significant differences in clinical outcomes or key quality outcome measures.
Methods: We included consecutive patients who underwent PPCI at 47 hospitals in Michigan from January 2010 to December 2015. From this overall cohort, 4,091 patients from sites with and without on-site cardiac surgery were propensity matched in a 1:1 fashion to compare baseline characteristics, procedural details, and in-hospital outcomes.
Results: Of the 25,886 PPCI’s performed at 47 hospitals in Michigan from 2010 to 2015, 21,610 (83.5%) were performed at sites with on-site cardiac surgery and 4,276 (16.5%) at sites without on-site cardiac surgery. Using propensity score matched cohorts (4,091 patients for each site type) we found no significant differences in baseline characteristics. Overall mortality (5.4% vs. 5.8%; p = 0.442), and composite mortality and morbidity (contrast-induced nephropathy, stroke, bleeding, urgent/emergent CABG, or length of stay) showed no significant differences. However, significant differences in procedural access site, antiplatelet therapy, and anticoagulant strategy were seen.
Conclusions: In conclusion, primary PCI performed at centers with and without cardiac surgery have comparable outcomes and complication rates, when performed with close monitoring of quality and outcomes.