CALIFORNIA REVASCULARIZATION: PCI OUTCOMES IN THE SUNSHINE STATE
William J. Bommer, M.D., University of California Davis, Medical Center, Davis, CA, USA
Introduction: In California (CA), 141 hospitals perform percutaneous coronary intervention (PCI) with 122 hospitals reporting to the NCDRŽ CathPCI registry.
Objective: To evaluate the PCI volume and composite event outcomes in hospitals with surgery On-site versus hospitals with surgery Off-site in CA.
Methods: We examined consecutive NCDRŽ records for PCI in CA from July 2010 to July 2012. Clinical data from 200 fields obtained from 6 pilot hospitals participating in the PCI-CA Audit-Monitored-Pilot-Off-site-Surgery (PCI-CAMPOS) program were compared with NCDRŽ de-identified clinical data from 116 CA hospitals with surgery On-site. Observed composite events (in-hospital death and emergent CABG), mortality, MI biomarkers, cardiogenic shock, heart failure, stroke, tamponade, dialysis, other vascular complications, transfusion and bleeding were obtained from both groups. Risk models were developed using bivariate and multivariate logistic regression.
Results: A total of 101,933 PCIs were performed (99,332 On-site including 17,577 STEMI cases and 2,601 Off-site including 837 STEMI cases). Bivariate analysis identified 22 significant variables. The Multivariate Logistic Regression Model demonstrated excellent prediction with a C-statistic of 0.902-0.903. The risk-adjusted composite event rate was 2.11% (On-site) and 1.58% (Off-site) for all cases and 1.16% (On-site) and 1.15% (Off-site) for STEMI excluded cases. On-site hospitals risk-adjusted composite events were as expected (105) with 4 better and 7 worse outliers. Off-site hospitals risk-adjusted composite events were as expected (5) with 1 better outlier.
Conclusion: PCI risk-adjusted composite event rates for 6 hospitals in the PCI-CAMPOS pilot program were similar to the composite event rates of 116 CA hospitals with On-site surgery.