The American Medical Association has published a study in which Mayo clinic researchers have reported that, contrary to current guidelines, there is no increased risk of death or emergency bypass surgery for elective or primary patients with previous heart attacks, who have angioplasties performed at centers without on-site cardiac surgery capabilities. The results of the study suggest care methods for heart attack patients and for the performance of angioplasties at centers without on-site surgery.
The researchers conducted a systematic search on papers published between 1990 and 2010 in several medical databases, which related to angioplasties performed at centers with and without on-site surgery. They identified fifteen studies that met the inclusion criteria. They discovered that from 124,074 patients who received primary angioplasties, the mortality rate was 4.6% for sites without on-site surgery and 7.2% for those with on-site surgery.
Lead researcher Mandeep Singh, M.D., cardiologist at the Mayo Clinic, says:
“More than 900,000 patients had angioplasty done in an elective or urgent setting. Again, we did not find any higher risk of in-hospital death in patients who had their angioplasties performed at centers with on-site surgery compared to centers without. This study demonstrates that any type of angioplasty can be safely performed at centers that do not have on-site surgical capability.”
The researchers also discovered that centers without on-site surgery capabilities had a low incidence of emergency coronary artery bypass surgery for both classifications of patients.
The observed rate of emergency cardiac surgery for primary angioplasty in patients with heart attacks was 0.22% at centers without on-site surgery compared with 1.03% at centers with on-site surgery, whilst the rates of emergency heart surgery for all other patients were 0.17% at centers without and 0.29% for centers with on-site surgery.
The American College of Cardiology and American Heart Association (ACC/AHA) recently revised recommendations in their published guidelines in favor of performing angioplasty at centers without on-site surgery.
Dr. Singh comments:
“Our study that combines the results of a large number of more recent studies with similar outcomes of angioplasties at centers with and without on-site surgery, provides further evidence in support of safety of angioplasty procedures at centers without on-site surgical facilities.”
Written by Petra Rattue