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Evaluation of Off-Site PCI Centers Without On-Site Cardiac Surgery

This report from the NCDR ACC/SCAI i2 Summit analyzes PCI outcomes, success rates, and complications between Off-Site and On-Site facilities. Off-Site programs treat a higher MI subset and show comparable effectiveness in PCI despite lower bed capacity and annual volume.

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Evaluation of Off-Site PCI Centers Without On-Site Cardiac Surgery

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  1. Percutaneous Coronary Interventions in Facilities without On-Site Cardiac Surgery: A Report from the National Cardiovascular Data Registry (NCDR) ACC/SCAI – i2 Summit Late Breaking Clinical Trials March 29, 2008

  2. Study Population

  3. MI Presentation

  4. Procedural Success and Complications

  5. Observed Outcomes: All PCI Patients (P<.0001) (P=0.3560) (P=0.8838) (P<.0001)

  6. Risk Adjusted Outcomes Odds Ratio (OR): outcomes for patients at On-Site (vs. Off-Site) facilities adjusting for site correlations and potential confounding variables

  7. Conclusions • Compared to On-Site PCI centers, Off-Site PCI programs participating in the NCDR: • Have smaller bed capacities. • Are predominantly located in rural and suburban areas. • Have lower annual PCI volume. • Treat a higher percentage of patients who present with subsets of MI (STEMI and NSTEMI). • Have better reperfusion times in primary PCI.

  8. Conclusions • Compared to On-Site PCI centers, Off-Site PCI programs have similar observed: • Procedure success • Morbidity • Emergency surgery rates • Mortality in cases that require emergency surgery • The risk-adjusted mortality rate in Off-Site facilities was comparable to those PCI centers that have cardiac surgery on-site.

  9. Implications • Off-Site PCI centers can provide excellent care to patients – if the program is developed with thoughtfulness and safety. • Our results are derived from PCI programs who have demonstrated a strong commitment to quality and attention to key structure, process, and outcomes measurements. Without such a commitment, similar results might not be achievable.

  10. Implications • The results of our study should not be extrapolated to encourage the wide-spread proliferation of Off-Site PCI programs. • Our study confirms the safety of an Off-Site PCI strategy at centers where rigorous clinical, operator, and institutional criteria are in place and are monitored to assure high quality outcomes.

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