The “fly in the ointment” came in a 2004 study of 1,121 hospitals. The study found that there were higher mortality rates among nonprimary PCI cases performed in hospitals without surgical backup, especially those that performed a small number of the procedures each year, said Dr. Michael Cowley, professor of medicine at Virginia Commonwealth University, Richmond, during a January conference in Snowmass, Colo., sponsored by SCAI and the ACC (JAMA 2004;292:1961–8).
Dr. Dehmer said in his press briefing that the safety issue will become clearer with the first large randomized trial comparing PCI rates at hospitals with and without surgical backup.
That trial, the Atlantic Cardiovascular Patient Outcomes Research Team Elective Angioplasty Study (CPORT), will enroll 18,000 patients.
In the meantime, the SCAI safety guidelines “focus on the goal of providing the best possible care to patients who require PCI, regardless of the setting.”
“Ensuring that all PCI programs meet appropriate performance metrics is likely to save more lives than requiring all PCI programs have on-site surgery,” noted the society's executive summary.
The summary acknowledged there is “clearly a potential for unnecessary or inappropriate PCI program development in the same geographic area.”
In addition, it stressed that such actions driven by financial or market gain are “strongly discouraged.”
In his President's Page to members, Dr. Dehmer said that “it was the belief of the Society that remaining silent in the face of this growing practice simply avoided the issue, and would not be the correct course.”
He also said cardiologists may need a “dose of reality” in recognizing that some patients may place a higher priority on “personal rather than medical considerations” when it comes to moving to a different facility for PCI.
“Having a surgeon on-site and just waiting for a failed PCI may be ideal, but it is not a realistic solution for the foreseeable future,” he wrote.
Finally, Dr. Dehmer said a larger message “not meant to be hidden” within the document is that ideal quality standards are not being met at every institution or by every interventional cardiologist.
“The message is QUALITY and promoting quality among all PCI facilities,” he told members in his president's message online.
The SCAI report, as well as the president's message, are available online at www.scai.org
ELSEVIER GLOBAL MEDICAL NEWS
“Despite the guidelines, this practice is going on in this country and it's growing,” SCAI President Gregory J. Dehmer said. Scott & White Clinic