Opening Arteries Without Surgical Backup

Coronary artery disease may be treated safely with angioplasty without hospital surgery support

(RxWiki News) When arteries are blocked, angioplasty may restore blood flow. Because complications from angioplasty are few, it may be performed safely at hospitals without on-site cardiac surgery.

Historically, hospitals that had cardiac surgery backup performed angioplasty. Emergency surgical services were at the ready in case there were complications.

Today, the procedure can be performed safely and effectively at hospitals without on-site cardiac surgery capability, according to new research.

"Research options when treating your heart."

Alice Jacobs, MD, professor of medicine at Boston University School of Medicine, and her team conducted a study comparing the safety and effectiveness of non-emergency angioplasty at two types of hospital settings—with cardiac surgery backup and without.

A total of 3,691 patients were randomly assigned in a 3:1 ratio to undergo angioplasty—2,774 went to hospitals without on-site cardiac surgery and 917 went to hospitals with surgical support.

The average age of the participants was 64 years old. A total of 32 percent were women, 32 percent had diabetes and 61 percent had an acute coronary syndrome.

During angioplasty (or percutaneous cardiac intervention), a tiny balloon is inflated within a coronary artery to push away plaque that is causing a blockage in the vessel, according to Johns Hopkins Medicine.

Stents, which act like tiny scaffolds, also can be put in place to keep the artery open. In rare cases, the procedure can cause a tear in the vessel or closing of the artery, requiring open heart surgery to repair the problem.

At 30 days after percutaneous cardiac intervention and at the 12-month follow-up mark, rates of major adverse events were about the same in both groups of patients. These events included heart attack, repeat angioplasty and stroke.

In the group without cardiac surgery backup, the rate of adverse events was 9.5 percent at 30 days and 17.3 percent at 12 months. In the group with cardiac surgery backup, the rate of adverse events was 9.4 percent at 30 days and 17.8 percent at 12 months.

At the site without surgery backup, seven patients required emergency transfer to a hospital for surgery and none died.

Scientists also observed no differences between patient groups with regards to procedure success rates, completeness of angioplasty or the proportion of lesions in a randomly selected sample of 376 patients.

“Our results suggest that performance of angioplasty in hospitals without cardiac surgery but with the appropriate experience, established angioplasty programs and the required hospital and operator volume, is an acceptable option for patients," said Dr. Jacobs in a press statement.

Some states restrict hospitals that don’t offer cardiac surgery from performing angioplasty, which is a minimally invasive procedure performed by specially trained cardiologists rather than cardiac surgeons, according to information from news@JAMA and Johns Hopkins Medicine.

In a 2011 statement, Johns Hopkins Medicine said that some hospitals had felt pressured to create costly cardiac surgery programs so that they can offer angioplasty.

This study adds to the growing body of evidence supporting favorable outcomes for patients undergoing elective or non-emergency angioplasty at hospitals without cardiac surgery on-site.

The study was presented in March at the American College of Cardiology's 62nd Annual Scientific Session is San Francisco. The findings should be considered preliminary until published in a peer-reviewed journal.

Review Date: 
March 19, 2013