TRENDS AND OUTCOMES DURING EARLY ROLLOUT PHASE OF NON-PRIMARY PCI AT CENTERS WITHOUT SURGERY ON-SITE: THE MICHIGAN EXPERIENCE
Afana M, Koenig G, Seth M, Frazier K, Fielding S, Jensen A, and Gurm H. TRENDS AND OUTCOMES DURING EARLY ROLLOUT PHASE OF NON-PRIMARY PCI AT CENTERS WITHOUT SURGERY ON-SITE: THE MICHIGAN EXPERIENCE. J Am Coll Cardiol 2019; 73(9):130.
J Am Coll Cardiol
Background: Non-primary percutaneous coronary intervention (non-PPCI) recently received certificate of need approval in the state of Michigan to be performed at sites without cardiac surgery on-site (SoS). The approval process requires mandatory participation in BMC2 registry with a rigorous audit and quality oversight program. This study sought to compare outcomes of patients undergoing non-PPCI at centers with and without SoS in the state of Michigan during the introductory phase. Methods: Consecutive patients who underwent non-PPCI at 48 hospitals in Michigan from April 2016 to March 2018 were included. From this cohort, 4,643 patients from sites with and without SoS were propensity score matched in a 1:1 fashion to compare baseline characteristics, procedural details, and in-hospital outcomes. Additionally, trends in non-PPCI distribution among sites were assessed. Results: Of the 61,864 PCI's performed during the study period, 50,817 were non-PPCI's, with 46,096 (90.7%) performed at sites with SoS and 4,721 (9.3%) performed at sites without SoS. Propensity score matching was successful in constructing cohorts with only minor differences in baseline characteristics. Overall mortality (0.6% vs. 0.5%; p=0.465), and major adverse cardiac events, along with other secondary individual clinical and quality outcomes, showed no significant differences, but a trend toward higher stroke and heart failure outcomes at sites with SoS. There were significant differences in arterial access site with surgical sites more frequently using femoral (52.2% vs. 43.0%; p<0.001), and non-surgical sites more frequently using radial access (47.4% vs. 56.7%; p<0.001). Finally, while overall statewide PCI volume remained relatively steady during the study period, there was a near three-fold rise in performance of non-PPCI at sites without on-site surgery. Conclusion: In the first year of approval, non-primary PCI at centers without cardiac surgery on-site was associated with comparable outcomes and quality compared with centers with cardiac surgery on site. The mandatory rigorous quality oversight process that was put in place by state regulations can serve as a model for similar programs elsewhere.