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Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry.

Authors
  • Nakamura, Chie1
  • Ebisawa, Soichiro2
  • Miura, Takashi3
  • Nomi, Hidetomo1
  • Kanzaki, Yusuke1
  • Yui, Hisanori1
  • Maruyama, Shusaku1
  • Nagae, Ayumu1
  • Ueki, Yasushi1
  • Sakai, Takahiro1
  • Kato, Tamon1
  • Saigusa, Tatsuya1
  • Okada, Ayako1
  • Motoki, Hirohiko1
  • Kuwahara, Koichiro1
  • 1 Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan. , (Japan)
  • 2 Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-shi, Nagano, 390-8621, Japan. [email protected] , (Japan)
  • 3 Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan. , (Japan)
Type
Published Article
Journal
Heart and Vessels
Publisher
Springer-Verlag
Publication Date
Jul 01, 2022
Volume
37
Issue
7
Pages
1106–1114
Identifiers
DOI: 10.1007/s00380-021-02015-6
PMID: 34997289
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (-) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan-Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities. © 2022. The Author(s).

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