{"id":14655,"date":"2011-12-15T13:23:00","date_gmt":"2011-12-15T18:23:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&#038;p=14655"},"modified":"2011-12-15T13:37:30","modified_gmt":"2011-12-15T18:37:30","slug":"pci-and-on-site-cabg-out-of-site-out-of-mind","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/12\/15\/pci-and-on-site-cabg-out-of-site-out-of-mind\/","title":{"rendered":"PCI and On-Site CABG: Out of Site, Out of Mind?"},"content":{"rendered":"<p>According to a <a href=\"http:\/\/jama.ama-assn.org\/content\/306\/22\/2487.short\">recent meta-analysis<\/a> of studies in patients undergoing PCI, rates of in-hospital mortality and emergency CABG for primary and non-primary PCI were similar at centers with and without on-site surgery.\u00a0 At least, that\u2019s the story the press is spreading around.<\/p>\n<p>However, several caveats should be noted . . .<\/p>\n<p>1. The study included patients undergoing primary PCI (for STEMI, n=124,074) and those undergoing\u00a0non-primary PCI (elective\u00a0or urgent, n=914,288).<\/p>\n<ol>\n<ul>\n<li>After \u201cadjustment for publication bias,\u201d the <strong><em>mortality rates for non-primary PCI were approximately 25% higher at centers without on-site surgery than at centers with on-site surgery<\/em><\/strong>.<\/li>\n<li>In\u00a0patients undergoing primary PCI, the emergency CABG rates were lower at sites without on-site surgery than at those with on-site surgery, raising the concern that \u201cborderline\u201d stable <strong><em>patients with suboptimal PCI results may have been kept at their local facility instead of being transported<\/em><\/strong> emergently to a surgical center.<\/li>\n<\/ul>\n<\/ol>\n<p>2. Few of the studies reported a composite end point of death and emergency CABG surgery; therefore, it is possible that one outcome was\u00a0exchanged for the other (i.e.,\u00a0failure to\u00a0transfer\u00a0precluded\u00a0emergency CABG and increased\u00a0death rates in patients undergoing PCI at sites without on-site CABG).<\/p>\n<p>3. The relationship between outcomes and PCI volume of centers or operators was not examined.<\/p>\n<p>Based on what you know,\u00a0<strong><em>would<strong> you<\/strong> be willing to have an elective PCI at a\u00a0center without on-site CABG capability<\/em><\/strong>?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>According to a recent meta-analysis of studies in patients undergoing PCI, rates of in-hospital mortality and emergency CABG for primary and non-primary PCI were similar at centers with and without on-site surgery.\u00a0 At least, that\u2019s the story the press is spreading around. However, several caveats should be noted . . . 1. The study included [&hellip;]<\/p>\n","protected":false},"author":190,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,9],"tags":[231,301],"class_list":["post-14655","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-interventional-cardiology","tag-cabg","tag-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14655","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/190"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=14655"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14655\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=14655"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=14655"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=14655"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}