Nonemergency PCI at Hospitals with or without On-Site Cardiac Surgery

Alice K. Jacobs, M.D., Sharon-Lise T. Normand, Ph.D., Joseph M. Massaro, Ph.D., Donald E. Cutlip, M.D., Joseph P. Carrozza, Jr., M.D., Anthony D. Marks, M.D., Nancy Murphy, B.A., Iyah K. Romm, B.S., Madeleine Biondolillo, M.D., and Laura Mauri, M.D. for the MASS COMM Investigators.
NEJM. March 11, 2013. DOI: 10.1056/NEJMoa1300610
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Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain.


A total of 3691 patients were randomly assigned to undergo PCI at a hospital without on-site cardiac surgery (2774 patients) or at a hospital with on-site cardiac surgery (917 patients). The rates of major adverse cardiac events were 9.5% in hospitals without on-site cardiac surgery and 9.4% in hospitals with on-site cardiac surgery at 30 days (relative risk, 1.00; 95% one-sided upper confidence limit, 1.22; P<0.001 for noninferiority) and 17.3% and 17.8%, respectively, at 12 months (relative risk, 0.98; 95% one-sided upper confidence limit, 1.13; P<0.001 for noninferiority). The rates of death, myocardial infarction, repeat revascularization, and stroke (the components of the primary end point) did not differ significantly between the groups at either time point.


Nonemergency PCI procedures performed at hospitals in Massachusetts without on-site surgical services were non-inferior to procedures performed at hospitals with on-site surgical services with respect to the 30-day and 1-year rates of clinical events. (Funded by the participating hospitals without on-site cardiac surgery; MASS COM number, NCT01116882.)