Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan, United States of America.
Wayne State University, School of Medicine, Detroit, Michigan, United States of America.
PLoS One. 2020 Aug 26;15(8):e0238048. doi: 10.1371/journal.pone.0238048. eCollection 2020.
Non-primary percutaneous coronary intervention (non-PPCI) recently received certificate of need approval in the state of Michigan at sites without cardiac surgery on-site (cSoS). This requires quality oversight through participation in the BMC2 registry. While previous studies have indicated the safety of this practice, real-world comprehensive outcomes, case volume changes, economic impacts, and readmission rates at diverse healthcare centers with and without cSoS remain poorly understood.
Consecutive patients undergoing non-PPCI at 47 hospitals (33 cSoS and 14 non-cSoS) in Michigan from April 2016 to March 2018 were included. Using propensity-matching, patients were analyzed to assess outcomes and trends in non-PPCI performance at sites with and without cSOS.
Of 61,864 PCI's performed, 50,817 were non-PPCI, with 46,096 (90.7%) performed at sites with cSoS and 4,721 (9.3%) at sites without cSoS. From this cohort, 4,643 propensity-matched patients were analyzed. Rates of major adverse cardiac events (2.6% vs. 2.8%; p = 0.443), in-hospital mortality (0.6% vs. 0.5%; p = 0.465), and several secondary clinical and quality outcomes showed no clinically significant differences. Among a small subset with available post-discharge data, there were no differences in 90-day readmission rates, standardized episode costs, or post-discharge mortality. Overall PCI volume remained stable, with a near three-fold rise in non-PPCI at sites without cSoS.
Non-PPCI at centers without cardiac SoS was associated with similar comprehensive outcomes, quality of care, 90-day episode costs, and post-discharge mortality compared with surgical sites. Mandatory quality oversight serves to maintain appropriate equivalent outcomes and may be considered for other programs, including the performance of non-PPCI at ambulatory surgical centers in the near future.
最近，密歇根州在没有心脏外科手术的现场（cSoS）的场所批准了非主要经皮冠状动脉介入治疗（非 PPCI）的需求证书。这需要通过参与 BMC2 登记处来进行质量监督。虽然之前的研究表明这种做法是安全的，但在有和没有 cSoS 的不同医疗中心的实际综合结果、病例量变化、经济影响和再入院率仍然知之甚少。
本研究纳入了 2016 年 4 月至 2018 年 3 月在密歇根州的 47 家医院（33 家 cSoS 和 14 家非 cSoS）接受非 PPCI 的连续患者。通过倾向评分匹配，分析患者以评估有和没有 cSoS 的医院的非 PPCI 表现的结果和趋势。
在 61864 例 PCI 中，50817 例为非 PPCI，其中 46096 例（90.7%）在有 cSoS 的医院进行，4721 例（9.3%）在没有 cSoS 的医院进行。从这个队列中，分析了 4643 例匹配的患者。主要不良心脏事件（2.6%比 2.8%；p=0.443）、院内死亡率（0.6%比 0.5%；p=0.465）和一些次要临床和质量结果没有显示出临床显著差异。在一小部分有出院后数据的患者中，90 天再入院率、标准化发作成本或出院后死亡率没有差异。总体 PCI 量保持稳定，没有 cSoS 的医院的非 PPCI 量几乎增加了三倍。
在没有心脏 SoS 的中心进行非 PPCI 与手术部位相比，综合结果、护理质量、90 天发作成本和出院后死亡率相似。强制性质量监督有助于维持适当的等效结果，并可能在未来考虑其他计划，包括在不久的将来在门诊手术中心进行非 PPCI。
