Z Kardiol 94: Suppl 2 (2005)

Outcome of PTCA in hospitals with and without on-site cardiac surgery backup: Data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) .

 
J. Carlsson1, B. Lagerqvist2
1Medicinsk klinik, Länssjukhuset, Kalmar, SE; 2Department of Cardiology, Akademiska University Hospital, Uppsala, BusinessLogic.Land;

The requirement of on-site surgical back-up is a debated issue since the beginning of percutaneous transluminal coronary angioplasty (PTCA). Last year an USAmerican study has reported a worse outcome in hospitals without surgical back-up (JAMA 2004;292:1961-68).

The data of Swedish Coronary Angiography and Angioplasty Registry (SCAAR) have been used to investigate the differences in outcome between hospitals with (SB) and without (NOSB) on-site surgical standby. SCAAR consists of all patients from all centers performing coronary angiography and PTCA in Sweden. Vital status of the patients could be followed combining SCAAR and the Swedish National Population Register.

The analysis included a total of 34361 procedures between January 2003 and December 2003. 8836 procedures were done in SB hospitals, 25525 in NOSB hospitals. The mean age of the patients was 64.1 (SB) and 64.5 years (NOSB; p=0.002). More patients in NOSB hospitals had diabetes (17.8% versus 16,8%; p=0.03). Other clinical characteristics (previous infarct, previous CABG) showed also a tendency of “worse” patients being treated in NOSB hospitals. However, there was a higher percentage of patients with STEMI (18.0% versus 9.7%; p<0.001) in SB hospitals. The unadjusted outcome data showed the following differences (SB versus NOSB; p-value): death 2.2% vs. 1.4%; <0.001, emergency CABG 0.2% vs. 0.1%; =0.02, neurologic complication 0.2 vs. 0.3%; 0.16. After adjustment for differences in baseline characteristics was no difference found regarding major outcome data (emergency CABG after PTCA, neurologic complications and 30-day mortality). Some results of the logistic regression analysis of 30-day mortality are shown in the table.

Variable

95% CI

p

Site (NOSB versus SB)

0.682 - 1.073

0.18

Age

1.045 - 1.064

<0.001

No diabetes (versus diabetes)

0.386 – 0.877

<0.001

Stable angina (versus STEMI/NSTEMI/UA)

0.396 – 0.696

<0.001

Previous infarct (vs. no infarct)

1.073-1.463

0.004

This analysis could not confirm recently reported differences in PTCA outcome between hospitals with and without on-site surgery backup. This might in part be due to large differences in PTCA volumes between USAmerican and European hospitals. While 98.3% of the reported USAmerican NOSB hospitals (22.1% of SB hospitals) performed < 101 PTCA per year, did the present analysis not include a single hospital with such a low number of procedures. On the basis of these data it does not seem warranted to recommend against PTCA in hospitals without on-site cardiac surgery backup.

 


http://www.abstractserver.de/dgk2005/ht/abstracts/P494.htm