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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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\u003EPerformance of elective percutaneous coronary intervention (PCI) at hospitals with and without on-site open heart surgery backup produces similar rates of mortality and major adverse cardiac events, according to clinical outcomes from the Cardiovascular Patient Outcomes Research Team (CPORT) Non-Primary PCI Trial [CPORT-E; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00549796\u0026amp;atom=%2Fspmdc%2F12%2F4%2F17.atom\u0022\u003ENCT00549796\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPerformance of elective percutaneous coronary intervention (PCI) at hospitals with and without on\u2013site open heart surgery backup produces similar rates of mortality and major adverse cardiac events (MACE), according to clinical outcomes from the Cardiovascular Patient Outcomes Research Team (CPORT) Non\u2013Primary PCI Trial [CPORT\u2013E; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00549796\u0026amp;atom=%2Fspmdc%2F12%2F4%2F17.atom\u0022\u003ENCT00549796\u003C\/a\u003E]. Thomas Aversano, MD, Johns Hopkins University, Baltimore, Maryland, USA, presented findings from the study [Aversano T et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis first randomized noninferiority trial that was designed to address concerns about the need for emergency cardiac surgery to treat complications that are related to nonprimary PCI, CPORT\u2013E had two primary endpoints: 1) all\u2013cause mortality 6 weeks after the index PCI, and 2) composite of MACE 9 months after the index PCI, including death from all causes, Q\u2013wave myocardial infarction (MI), or target\u2013vessel revascularization (TVR).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EInclusion criteria included patients aged \u226518 years with stable coronary disease or an acute coronary syndrome. Patients with an acute ST\u2013segment elevation MI (STEMI) or an ejection fraction of \u0026lt;20%, patients who required PCI of an unprotected left main coronary artery, and others who were considered to be at too high a risk in the judgment of the treating physician were excluded. A total of 60 centers with an annual mean procedural volume of 150 cases participated in the trial.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ECPORT\u2013E randomized a total of 18,867 patients in a 3:1 ratio to undergo PCI at a hospital without on\u2013site cardiac surgery (n=14,149) or with on\u2013site cardiac surgery (n=4718). Noninferiority margins for the risk difference were an absolute increase in risk of no more than 0.4% for mortality at 6 weeks and 1.8% for MACE at 9 months.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe 6\u2013week mortality rates were 0.9% at hospitals without versus 1.0% with on\u2013site surgery (ie, an absolute risk difference of \u22120.04%; 95% CI, \u22120.31% to +0.23%; the upper 95% CI was less than the noninferiority margin of 0.4%; p value for noninferiority=0.004; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The respective 9\u2013month rates of MACE were 12.1% and 11.2% at hospitals without and with on\u2013site surgery (ie, an absolute risk difference of +0.92%; 95% CI, +0.04% to +1.80%; the upper 95% CI was equal to the noninferiority margin of 1.8%; therefore, the one\u2013sided p value for noninferiority=0.05; \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). The rate of TVR was significantly higher in hospitals without on\u2013site surgery (6.5% vs 5.4%; p value for superiority of on\u2013site surgery=0.01).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14001\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14001\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14001\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMortality at 6 Weeks.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14002\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14002\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14002\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EMACE at 9 Months.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EWhen only patients who were treated per protocol were analyzed (excluding patients who crossed over), the respective 9\u2013month rates of MACE were 12.0% and 10.4% at hospitals without and with on\u2013site surgery (ie, an absolute risk difference of +1.64%; 95% CI, +0.77% to +2.51%); the upper 95% CI was higher than the noninferiority margin of 1.8%; therefore, the one\u2013sided p value for noninferiority was not significant and treatment at non\u2013on\u2013site surgery hospitals were not equivalent to treatment at on\u2013site surgery hospitals.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ESix weeks after the index PCI, mortality was similar among hospitals with and without on\u2013site surgery; in addition, the incidence of bleeding, renal failure, and stroke was similar among both kinds of facilities. However, unplanned coronary artery bypass grafting (CABG) surgery, especially emergency CABG, was more frequent among patients who were assigned to hospitals with on\u2013site surgery; yet, unplanned catheterization and PCI procedures were more frequent among patients who were assigned to non\u2013on\u2013site surgery hospitals. The rate of PCI failure was higher among participants who were treated at hospitals without on\u2013site surgery.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EDr. Aversano and colleagues concluded that \u201cnonprimary PCI outcomes at hospitals without on\u2013site cardiac surgery are noninferior to those with on\u2013site cardiac surgery, if the former completes a formal PCI development program, adheres to C\u2013PORT\u2013E participation requirements, and has outcomes monitored.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EHowever, higher rates of subsequent TVR among patients who were treated at non\u2013on\u2013site surgery hospitals contributed to a 0.92% absolute higher rate of MACE at 9 months, with a 95% upper CI of 1.8% that equaled the noninferiority border. The authors suggested within their manuscript that the reasons for an incomplete initial revascularization were unclear \u201cbut may reflect a lower initial success rate and a more conservative approach by interventionalists practicing at relatively inexperienced centers that began PCI programs only as part of the CPORT\u2013E trial.\u201c Additional studies would be helpful to further clarify the comparison of longer\u2013term results of PCI between these two types of facilities.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\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\/12\/4\/17.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?nznhip\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznhip\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}