Patient Access and 1-Year Outcomes of Percutaneous Coronary Intervention Facilities With and Without On-Site Cardiothoracic Surgery
| Autor: | Thomas T. Tsai, Thomas M. Maddox, Robert J. Jesse, Steven M. Bradley, Mary E. Plomondon, Maggie A. Stanislawski, Colin O'Donnell, John S. Rumsfeld, Bernadette Speiser, Adhir R. Shroff, P. Michael Ho |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Patient Identification Systems medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Revascularization Health Services Accessibility Percutaneous Coronary Intervention Physiology (medical) Outcome Assessment Health Care Health care medicine Humans Angina Unstable Registries Myocardial infarction Coronary Artery Bypass Veterans Affairs Aged business.industry Percutaneous coronary intervention Middle Aged medicine.disease United States Clinical trial United States Department of Veterans Affairs Cardiothoracic surgery Conventional PCI Emergency medicine Female Stents Medical emergency Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 130:1383-1391 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.114.009713 |
| Popis: | Background— The safety of percutaneous coronary intervention (PCI) at medical facilities without on-site cardiothoracic (CT) surgery has been established in clinical trials. However, the comparative effectiveness of this strategy in real-world practice, including impact on patient access and outcomes, is uncertain. The Veterans Affairs (VA) health care system has used this strategy, with strict quality oversight, since 2005, and can provide insight into this question. Methods and Results— Among 24 387 patients receiving PCI at VA facilities between October 2007 and September 2010, 6616 (27.1%) patients underwent PCI at facilities (n=18) without on-site CT surgery. Patient drive time (as a proxy for access), procedural complications, 1-year mortality, myocardial infarction, and rates of subsequent revascularization procedures were compared by facility. Results were stratified by procedural indication (ST–segment-elevation myocardial infarction versus non–ST–segment-elevation myocardial infarction/unstable angina versus elective) and PCI volume. With the inclusion of PCI facilities without on-site CT surgery, median drive time for patients treated at those facilities decreased by 90.8 minutes ( P Conclusions— This study suggests that providing PCI facilities without on-site CT surgery in an integrated health care system with quality oversight improves patient access without compromising procedural or 1-year outcomes. |
| Databáze: | OpenAIRE |
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