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Henry Ford Hospital
Objectives: This study sought to compare outcomes of patients undergoing non-primary percutaneous coronary intervention (non-PPCI) at centers with and without surgery on-site (SoS) in Michigan during the introductory phase.Background: Non-PPCI recently received certificate of need approval in the state of Michigan to be performed at sites without SoS. This requires mandatory participation in the BMC2 registry, which involves rigorous quality oversight. Methods: Consecutive patients who underwent non-PPCI at 47 hospitals in Michigan from April 2016 to March 2018 were included. From this cohort, 4,643 propensity matched patients, in a 1:1 fashion, were used 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%) at sites without SoS. While overall PCI volume remained relatively steady, there was a near three-fold rise in performance of non-PPCI at sites without SoS. In propensity matched cohorts, overall rate 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 other secondary clinical and quality outcomes, showed no clinically significant differences. Conclusion: In the two years since state approval, non-primary PCI at centers without cardiac SoS was associated with similar in-hospital outcomes and quality compared with centers with SoS. The mandatory rigorous quality oversight process that was put in place by state regulations can serve as a model for similar programs elsewhere.
Afana, Majed; Koenig, Gerald C; Seth, Milan; Frazier, Kathleen M; Fielding, Sheryl; Jensen, Andrea; and Gurm, Hitinder S, "Trends and Outcomes During Rollout Phase of Non-Primary PCI at Sites Without Surgery On-Site: The Michigan Experience" (2019). Clinical Research. 16.