Document Detail

Percutaneous coronary intervention at centers with and without on-site surgery: a meta-analysis.
MedLine Citation:
PMID:  22166608     Owner:  NLM     Status:  MEDLINE    
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 on-site surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery.
Mandeep Singh; David R Holmes; Gregory J Dehmer; Ryan J Lennon; Thomas P Wharton; Michael A Kutcher; Thomas Aversano; Charanjit S Rihal
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  JAMA     Volume:  306     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2011-12-15     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2487-94     Citation Subset:  AIM; IM    
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MeSH Terms
Ambulatory Care Facilities / standards*
Angioplasty* / adverse effects,  standards
Cardiac Surgical Procedures / statistics & numerical data*
Coronary Artery Bypass / statistics & numerical data
Emergency Medical Services / statistics & numerical data
Hospital Mortality*
Surgical Procedures, Elective
Comment In:
Nat Rev Cardiol. 2012 Feb;9(2):65   [PMID:  22231715 ]
JAMA. 2011 Dec 14;306(22):2507-9   [PMID:  22166613 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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