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Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience

INTRODUCTION: 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 ind...

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Autores principales: Afana, Majed, Koenig, Gerald C., Seth, Milan, Sukul, Devraj, Frazier, Kathleen M., Fielding, Sheryl, Jensen, Andrea, Gurm, Hitinder S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449474/
https://www.ncbi.nlm.nih.gov/pubmed/32845908
http://dx.doi.org/10.1371/journal.pone.0238048
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author Afana, Majed
Koenig, Gerald C.
Seth, Milan
Sukul, Devraj
Frazier, Kathleen M.
Fielding, Sheryl
Jensen, Andrea
Gurm, Hitinder S.
author_facet Afana, Majed
Koenig, Gerald C.
Seth, Milan
Sukul, Devraj
Frazier, Kathleen M.
Fielding, Sheryl
Jensen, Andrea
Gurm, Hitinder S.
author_sort Afana, Majed
collection PubMed
description INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-74494742020-09-02 Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience Afana, Majed Koenig, Gerald C. Seth, Milan Sukul, Devraj Frazier, Kathleen M. Fielding, Sheryl Jensen, Andrea Gurm, Hitinder S. PLoS One Research Article INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Public Library of Science 2020-08-26 /pmc/articles/PMC7449474/ /pubmed/32845908 http://dx.doi.org/10.1371/journal.pone.0238048 Text en © 2020 Afana et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Afana, Majed
Koenig, Gerald C.
Seth, Milan
Sukul, Devraj
Frazier, Kathleen M.
Fielding, Sheryl
Jensen, Andrea
Gurm, Hitinder S.
Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title_full Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title_fullStr Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title_full_unstemmed Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title_short Trends and outcomes of non-primary PCI at sites without cardiac surgery on-site: The early Michigan experience
title_sort trends and outcomes of non-primary pci at sites without cardiac surgery on-site: the early michigan experience
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449474/
https://www.ncbi.nlm.nih.gov/pubmed/32845908
http://dx.doi.org/10.1371/journal.pone.0238048
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