Performance and safety of complex percutaneous coronary intervention in centres without on-site cardiac surgery—A multicentre Australian registry study.

Abstract

Background: Performing complex percutaneous coronary intervention (PCI) procedures in hospitals with no on-site cardiac surgery (NOSCS) remains controversial due to a lack of contemporary data and guideline support. Methods: Victorian Cardiac Outcomes Registry data was analysed including all PCI cases in Victoria from 2014 to 2022. Patients were stratified by PCI at on-site cardiac surgery (OSCS) or NOSCS centres. Complex PCI was defined as PCI to unprotected left main, bifurcation lesions, rotational atherectomy or intravascular lithotripsy use, severe left ventricular systolic dysfunction, chronic total occlusion, or vein graft PCI. Primary outcome was composite MACCE at 30-days. Risk ratio for average treatment effect in the NOSCS cohort was estimated using inverse probability treatment weighting. Results: 94,268 total PCI procedures (32.6% NOSCS) were analysed, including 12,459 complex PCI cases (28.7% NOSCS). Patients from NOSCS were younger (65.0 vs 67.4, p<0.001), and had higher rates of NSTEMI (32.0% vs 28.0%, p<0.001) and STEMI (23.3% vs 15.2%, p<0.001). A propensity weighted sample of 30,850 OSCS patients and 30,692 NOSCS patients demonstrated no difference in adjusted 30-day MACCE (risk ratio 0.93, 95% CI 0.87–1.01, p=0.051) for all PCI procedures. In a propensity-weighted subgroup of 3,638 OSCS and 3,576 NOSCS complex PCI patients, there was also no difference in adjusted 30-day MACCE (risk ratio 0.97, 95%CI 0.86–1.09, p=0.60). Conclusion: Patients undergoing PCI and complex PCI at NOSCS centres had comparable 30-day outcomes to those treated at OSCS centres. Increasing PCI and complex PCI capabilities at NOSCS is likely to increase equitable treatment access for more patients.