The issue with performing angioplasty, a technique used to widen blood vessels, in hospitals without proper surgical units has long been a controversial topic. Many cardiologists claim that the lack of emergency care can lead to increased adverse events.
A study, officially called the Cardiovascular Patient Outcomes Research Team Elective Angioplasty Study (CPORT-E), was presented at the American College of Cardiology annual meeting in Chicago to address the concern of safety measures for angioplasty. Interestingly, the results showed that there is no exigent need to perform angioplasty in hospitals with an on-site cardiac surgical unit.
Emergency angioplasty is performed during a heart attack to remove the plaque stuck to vessels, blocking blood from travelling into the heart. During the procedure, a balloon is inflated in the vessel that has trapped the plaque and a stent is attached to keep the vessel open. In very rare cases, the procedure can cause rips in the vessel or collapse of the artery, which would require immediate cardiac surgery known as emergency coronary artery bypass.
There has been a great drop in the number of emergency surgeries needed during angioplasty. In 1979, 10 percent of patients required emergency coronary artery bypass grafting, while in 2002, the percentage dropped to 0.15 percent. Despite this decline, the concern for safety at sites without available emergency surgery units persisted.
Cardiologists reasonably claim that the lack of emergency surgery could lead to more adverse events due to the low number of procedures performed and inexperienced staff. Of course, even with a lowered incidence rate of emergency surgery, there were still cases that required coronary-artery bypass grafting to repair the tears incurred during angioplasty.
On the other hand, lifting any regulations that prohibit hospitals without an on-site surgical unit to perform angioplasty could potentially increase the survival of heart attack victims. The duration between the heart attack and the procedure, for one, can be significantly reduced if more local hospitals are permitted to perform it. This can subsequently improve the outcomes.
Extending primary angioplasty capabilities to hospitals can provide patients access to better therapeutic options for heart failure, especially in areas where the recruitment and retention of cardiologists are difficult.
Moreover, an increase in volume of these procedures in hospitals can eventually improve the performances and experience of the staff.
CPORT-E evaluated 18,867 angioplasty patients randomly chosen from hospitals with or without a cardiac surgical unit. After the 9-month study, it was found that the outcomes at hospitals without an on-site surgical unit did not differ significantly from outcomes at hospitals with an on-site surgical unit.
Thomas Aversano, an associate professor of cardiology at the Hopkins School of Medicine who led the study, admonished any oversimplification of the data from this study, however. He claimed that in spite of the conclusions of the study, it did not warrant unrestrained extensions of angioplasty programs.
According to Aversano, hospitals that participated in the study adhered to stringent procedures for the angioplasty development program, which was heavily supervised.
Furthermore, the hospitals qualified for the study only if they could maintain their angioplasty program 24 hours a day, seven days a week, and were sufficiently productive enough to perform at least 200 angioplasties a year. This excludes low-volume operators, which was one of the primary concerns of angioplasty performance.
As licensing agencies require compelling evidence that demonstrates the hospitals' capabilities, it will be a dilatory process to approve certain hospitals without on-site surgical units to perform angioplasty.
However, the study was not intended to expand the number of angioplasty programs. Instead, CPORT-E can provide health-care regulators with valuable information to decide appropriate geographic distribution of angioplasty performances in local areas.
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