03409nas a2200493   4500000000100000008004100001653001100042653001100053653000900064653000900073653002200082653001600104653002200120653001800142653002600160653003100186653004800217653002300265653005500288653003900343653001700382100001200399700001800411700001400429700001300443700001600456700001500472700001300487700001200500700001300512700002000525700001600545700001300561700001800574700001500592700001400607700001300621245012500634250001500759300001100774490000700785520207200792020005102864       2015                            d10aFemale10aHumans10aAged10aMale10aTreatment Outcome10aMiddle Aged10aAged, 80 and over10aSurvival Rate10aRetrospective Studies10aGreat Britain/epidemiology10aAngina, Stable/diagnosis/mortality/ surgery10aDatabases, Factual10aMyocardial Infarction/diagnosis/mortality/ surgery10aPercutaneous Coronary Intervention10aSurgicenters1 aGarg S.1 aWoodward Mark1 aPeters S.1 aEmdin C.1 aAnderson S.1 aOldroyd K.1 aBerry C.1 aWest N.1 aKelly D.1 aBalachandran K.1 aMcDonald J.1 aSingh R.1 aDevadathan S.1 aRedwood S.1 aLudman P.1 aRahimi K00aOutcomes of Percutaneous Coronary Intervention Performed at Offsite Versus Onsite Surgical Centers in the United Kingdom  a2015/07/25  a363-720 v663 a<p>
BACKGROUND: Percutaneous coronary intervention (PCI) is increasingly being performed at centers with offsite surgical support. Strong guideline endorsement of this practice has been lacking, in part because outcome data are limited to modest-size populations with short-term follow-up. OBJECTIVES: The aim of this study was to compare the outcomes of PCI performed at centers with and without surgical support in the United Kingdom between 2006 and 2012. METHODS: A retrospective analysis was performed of centrally tracked outcomes from index PCI procedures entered in the British Cardiovascular Intervention Society database between 2006 and 2012, stratified according to whether procedures were performed at centers with onsite or offsite surgical support. The primary endpoint was 30-day all-cause mortality, with secondary endpoints of mortality at 1 and 5 years. RESULTS: Outcomes at a median of 3.4 years follow-up were available for 384,013 patients, of whom 31% (n = 119,096) were treated at offsite surgical centers. In an unadjusted analysis, crude mortality rates were lower in patients treated at centers with offsite versus onsite surgical coverage (2.0% vs. 2.2%; p &lt; 0.001). On multivariate adjustment, there were no between-group differences in survival between the naive and imputed populations at 30 days (naive population hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.71 to 1.06; p = 0.16; imputed population HR: 0.99; 95% CI: 0.89 to 1.09; p = 0.82), 1 year (naive population HR: 0.92; 95% CI: 0.79 to 1.07; p = 0.26; imputed population HR: 0.99; 95% CI: 0.92 to 1.06; p = 0.78), or 5 years (naive population HR: 0.92; 95% CI: 0.84 to 1.01; p = 0.10; imputed population HR: 0.97; 95% CI: 0.92 to 1.03; p = 0.29). Results were consistent irrespective of procedural indication. No differences in mortality were seen in sensitivity analyses performed using a propensity-matched population of 74,001 patients. CONCLUSIONS: PCI performed at centers without onsite surgical backup is not associated with any mortality hazard.
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