Angioplasty Safe Sans Surgical Backup
With Proper Safeguards, Angioplasty Centers Are Safe Even Without Heart Surgery Team, Study Shows
Well-Run Centers Studied continued...
Results showed that the angioplasty procedure was a success at 94% of
hospitals that didn't have surgical backup and 93% of centers that did -- a
difference so small it could have been due to chance.
Fewer than four of every 1,000 patients in both groups needed emergency
bypass surgery. There were also similar rates of complications (6.4% vs. 6.3%,
respectively) and deaths (1.8% vs. 1.2%).
Kutcher says that the hospitals with off-site programs studied probably
represent the cream of the crop. A total of 92% were prepared to do angioplasty
24/7. In 75% of cases, the hospital where patients were taken in case of an
emergency was less than 30 minutes away.
Plus, the fact that they voluntarily submitted data to the national database
shows a commitment to quality, Kutcher says.
"These medical centers are very accomplished and represent the premier
programs offering PCI with off-site cardiac surgical backup," he says.
"And they are doing angioplasty for the right reasons: to improve outcomes
for heart attack patients and to better serve patients in remote geographic
A Change in Angioplasty Guidelines?
SCAI President Bonnie Wiener, MD, director of interventional research at
Saint Vincent Hospital in Worcester, Mass., says the findings could lead to a
re-examination of the guidelines.
"In the right circumstances, with the right quality and systems in
place, angioplasty without onsite surgery can be safe and effective," she
But what the researchers do not want is a "wild expansion of offsite
[angioplasty] programs" in urban areas that already have a lot of hospitals
with surgical backup, Kutcher says.
So what should you do if you or a family member has an elective angioplasty
coming up and there's no center with surgical backup nearby?
First, ask how long it will take to get to the closest center that offers
bypass surgery, Kutcher says. If it's more than 90 minutes away, explore other
options, he advises.
Regardless of whether backup is available, ACC guidelines recommend that you
go to a hospital that does at least 200 procedures a year. The cardiac
interventionalist should do 75 or more procedures annually, Kutcher says.
In the study, only 30% of programs without surgical backup performed more
than 200 procedures annually.
Also, ask if the interventionalist is board certified and if the hospital
reports its success rates to the National Cardiovascular Data Registry or is
otherwise reviewed by independent doctors, Kutcher advises. Both are signs of
well-run, quality programs, he says.