No Heart Surgery Center Required

Angioplasty after a heart attack is just as safe at hospitals without surgery centers

(RxWiki News) Patients had generally been urged to follow guidelines suggesting that they schedule non-emergency angioplasty, an artery opening procedure common after a heart attack, at hospitals with a dedicated surgical team.

They may be no reason to do so. Receiving angioplasty at a medical facility without heart surgery capabilities is not associated with an increased risk of dying or a later need for emergency coronary bypass surgery. The finding is especially significant because of its wide use to open blockages.

"Ask your cardiologist to recommend a center for angioplasty."

Dr. Mandeep Singh, a Mayo Clinic cardiologist and lead author of the study, noted that more than 900,000 patients underwent the procedure in reviewed studies, and still no heightened risk was found at facilities without cardiac surgical centers.

Dr. Singh said the research shows that the procedure is safe at hospitals without surgical capabilities.

During the review study investigators reviewed 15 studies regarding angioplasty performed at medical centers with and without cardiac surgical capabilities. Those studies were published between 1990 and 2010.

While reviewing a subset of 124,074 patients who required emergency angioplasty as a lifesaving procedure, the mortality rate was 4.6 percent for sites with no on-site surgery center as compared to 7.2 percent for hospitals with surgical capabilities.

The percentage may be slightly higher at hospitals with surgical centers because they are likely to perform more emergency procedures.

When emergency angioplasty was performed at hospitals without surgical teams, there was a .22 percent chance they would need emergency bypass surgery versus a 1.03 percent chance at hospitals with surgical teams.

Patients scheduling non-emergency angioplasty had less than a half a percent chance of requiring the emergency heart operation, regardless of whether a hospital had surgical capabilities.

Previously published guidelines from the American Heart Association and the American College of Cardiology only recently updated their guidelines to suggest that patients could have favorable outcomes when scheduling angioplasty at hospitals without cardiac surgery teams.

Dr. Singh said this latest study offers additional evidence suggesting that the procedure is just as safe at hospitals without dedicated surgery staff.

The research was recently published in the Journal of the American Medical Association.

Reviewed by: 
Review Date: 
December 16, 2011