Safety in numbers for community hospitals performing emergency angioplasty

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NEW ORLEANS—Life-saving coronary angioplasty at community hospitals is safer when physicians and hospital staff have more experience with the procedure, according to a study presented Wednesday at the American Heart Association (AHA) Scientific Sessions.

Researchers found that among 5,737 men and women who had emergency, so-called primary angioplasty for treatment of sudden heart attack, all at community hospitals with no on-site cardiac surgery backup, hospitals performing 83 or more procedures per year had the lowest death rates at the time of hospital discharge, at 2.2 percent.

“The results reinforce what we have known for a long time with many other technical procedures, such as organ transplantation or specialized heart surgery: From an institutional and physician perspective, the more procedures performed, the better the outcomes for the patient,” said Thomas Aversano, senior study investigator and an interventional cardiologist at Johns Hopkins University School of Medicine and its Heart and Vascular Institute in Baltimore.

Under present guidelines from the AHA and the American College of Cardiology (ACC), Aversano said that community hospitals are limited to offering angioplasty only in emergency situations, such as during a heart attack. In all other nonemergency or elective surgical cases, patients must be transferred to another hospital that has on-site, specialized heart surgery backup.

In the study—one of a number being conducted by the Cardiovascular Patient Outcomes Research Team (or C-PORT)—Aversano said that all participants had primary angioplasty in response to an MI. They adjusted for Mortality rates to account for factors that heighten risk, such as age, ability to tolerate clot-busting drugs, diabetes and the extent of blockages in coronary blood vessels.

The research is part of several C-PORT projects investigating the safety of performing angioplasty in hospitals without heart-surgery backup, led by Aversano.

He noted that even in lower volume hospitals, at no more than 46 procedures per year, the death rate is 4 percent. Previous research by Aversano, published in the Journal of the American Medical Association in 2002, showed that heart attack patients, who were treated with thrombolysis, had a 6.7 percent death rate.

“Even in low-volume community hospitals, survival rates are better for primary angioplasty than thrombolytic therapy," Aversano said.

"Our results serve as one potential motivation for expanding elective angioplasty to community hospitals without on-site cardiac surgery so that institutional volume is not restricted to emergency cases," he concluded.