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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAccording to a new analysis of data from the Massachusetts Data Analysis Center (MASS-DAC) registry, patients who are undergoing primary percutaneous coronary intervention for STEMI face similar risks of death and myocardial infarction but higher rates of repeat revascularization when treated at hospitals without on-site cardiac surgery capabilities compared with hospitals with cardiac surgery capabilities.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAccording to a new analysis of data from the Massachusetts Data Analysis Center (MASS-DAC) registry, patients who are undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) face similar risks of death and MI but higher rates of repeat revascularization when treated at hospitals without on-site cardiac surgery (non-SOS) capabilities compared with hospitals with cardiac surgery capabilities (SOS).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIf it can be performed quickly (within 90 minutes of initial medical contact), primary PCI is the preferred method of reperfusion in patients with STEMI, according to current American Heart Association\/American College of Cardiology guidelines. However, most patients with STEMI present to hospitals without SOS, where primary PCI is generally discouraged (eg, in Massachusetts). With limited access to immediate PCI, many patients with STEMI either are treated with fibrinolytic therapy or face potential delays in treatment in transfer to PCI centers.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAllowing primary PCI in hospitals without SOS could greatly expand access to timely PCI for STEMI patients. In 1997, the Massachusetts Department of Health initiated a pilot program for primary PCI at non-SOS hospitals. Ather Anis, MD, Boston University Medical Center, Boston, MA, presented findings from the MASS-DAC analysis, comparing outcomes of primary PCI in hospitals depending on the availability of SOS.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOf a total of 6139 patients in the MASS-DAC registry with STEMI who underwent PCI between 2005 and 2007, there were 3018 patients with complete data who were not transferred and were treated at centers with (n=2041) and without (n=977) cardiac surgery capabilities. Demographic, clinical, and angiographic variables were included in multivariate analyses, with propensity score-matching to minimize confounding. The primary outcomes were 30-day and 1-year all-cause mortality, MI, repeat revascularization, and target vessel revascularization.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients who were treated at non-SOS hospitals were more frequently white, covered by HMO insurance, and had multivessel disease. All-cause mortality was similar in centers with and without cardiac surgery capabilities at 30 days (4.5% vs 5.7%; p=0.22) and at 1 year (9.4% vs 8.6%; p=0.51). Although there was a trend toward increased risk of MI at 30 days at non-SOS hospitals (4.35% vs 2.82%; p=0.05), the risk of MI was similar at 1 year (6.7% vs 5.1%; p=0.11).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ETarget vessel revascularization rates were also similar at 30 days (6.3% vs 5.0%; p=0.21) and at 1 year (10.9% vs 9.7%; p=0.39). However, repeat revascularization rates were significantly higher in non-SOS centers through 30 days (14.9% vs 7.6%; p\u0026lt;0.0001) and 1 year (21.0% vs 14.7%; p\u0026lt;0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThis observational analysis suggests that primary PCI may be safely performed in patients who present with STEMI to non-SOS hospitals, with no differences observed in 30-day or 1-year mortality. Dr. Anis noted, however, that \u201cSTEMI patients undergoing primary PCI at hospitals without on-site cardiac surgery had a slightly higher incidence of recurrence [MI] at 30 days for reasons that are unclear and will require further study.\u201d Further analyses that account for differences in the timing of procedures and selection of patients who underwent PCI and other differences in patients between hospital types are pending.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/5\/14.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmhvd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}