1. ACC/SCAI – i2 Summit Late Breaking Clinical Trials March 29, 2008
Percutaneous Coronary Interventions in Facilities without On-Site Cardiac Surgery: A Report from the National Cardiovascular Data Registry (NCDR)
ACC/SCAI – i2 Summit
Late Breaking Clinical Trials
March 29, 2008

2. Study Population

3. MI Presentation

4. Procedural Success and Complications

5. Observed Outcomes: All PCI Patients

6. Risk Adjusted Outcomes
Odds Ratio (OR): outcomes for patients at On-Site (vs. Off-Site) facilities
adjusting for site correlations and potential confounding variables

7. Conclusions
Compared to On-Site PCI centers, Off-Site PCI programs participating in the NCDR:
Have smaller bed capacities.
Are predominantly located in rural and suburban areas.
Have lower annual PCI volume.
Treat a higher percentage of patients who present with subsets of MI (STEMI and NSTEMI).
Have better reperfusion times in primary PCI.

8. Conclusions
Compared to On-Site PCI centers, Off-Site PCI programs have similar observed:
Procedure success
Morbidity
Emergency surgery rates
Mortality in cases that require emergency surgery
The risk-adjusted mortality rate in Off-Site facilities was comparable to those PCI centers that have cardiac surgery on-site.

9. Implications
Off-Site PCI centers can provide excellent care to patients – if the program is developed with thoughtfulness and safety.
Our results are derived from PCI programs who have demonstrated a strong commitment to quality and attention to key structure, process, and outcomes measurements. Without such a commitment, similar results might not be achievable.

10. Implications
The results of our study should not be extrapolated to encourage the wide-spread proliferation of Off-Site PCI programs.
Our study confirms the safety of an Off-Site PCI strategy at centers where rigorous clinical, operator, and institutional criteria are in place and are monitored to assure high quality outcomes.