NEW ORLEANS, Nov. 14 – A new study raises a red flag for hospitals that perform non-emergency angioplasties without a surgical backup team.
Individuals undergoing non-emergency angioplasty in a facility that could not provide surgical backup were twice as likely to die, and 20 percent more likely to require bypass surgery for which they had to be transferred to another facility, according to a study presented today at the American Heart Association’s Scientific Sessions 2000.
Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure that is used to open clogged arteries in the heart. A tiny balloon is threaded into a catheter, which is then inserted into a clogged coronary artery where the balloon is inflated, widening the artery and expanding blood flow to the heart. When first introduced in the early 1980s, PTCA was performed only in hospitals with on-site surgical backup so that if anything went wrong, doctors could act quickly. However, as the procedure became more widespread and doctors recognized that they could often perform the procedure with few complications, physicians began to perform the PTCA increasingly without surgical backup.
“This study should serve as a cautionary flag,” says David E. Wennberg, M.D., M.P.H., the study’s lead investigator. “While single-institution reports have suggested that performing angioplasty without surgical backup is a safe procedure, our data suggest that does not hold true when you look at medical centers and hospitals across the United States.” Wennberg is director of the center for outcomes research and evaluation, Maine Medical Center in Portland, Maine.
Wennberg’s study addresses the ongoing controversy. While some physicians believe that the procedure can often be safely performed without surgical backup, others question whether the lack of a surgical team could escalate some patients’ risk for life-threatening complications.
Wennberg suggests that the importance of surgical backup depends on the reason for the angioplasty. In 1996 and 1997, researchers compared more than 2,500 angioplasties performed at 198 institutions across the country without surgical backup to about 365,000 performed in facilities with surgical backup. Patients in the study were Medicare beneficiaries. The researchers found that when an emergency angioplasty was performed – either a “primary” angioplasty at the time of a heart attack, or a “rescue” procedure when drugs failed to dissolve a blockage – the lack of surgical backup made no difference in patient outcomes. However, Wennberg reports that patients undergoing non-emergency angioplasty were much more likely to die or need another operation if their PTCA was performed in a facility without surgical backup.
Researchers plan to undertake further studies to try and understand why the risks are higher for non-emergency angioplasties, however it may relate to the severity of the person’s heart disease.
Co-authors are John D. Dickens, Jr., M.D.; F.L. Lucas, M.D.; Paul D. McGrath, M.D.; and David J. Malenka, M.D.
NR00-1189 (SS2000/Wennberg)