There may be no difference between patients undergoing elective PCI in the hospital outpatient department vs. ambulatory surgery center (ASC) for a composite of 30-day myocardial infarction (MI), bleeding complications and hospital admission, however the risk for bleeding complications may be higher in the ASC setting, according to research published Nov. 9 in JACC: Cardiovascular Interventions and being presented at AHA 2020.

As the Centers for Medicare and Medicaid Services now reimburses PCIs performed in ASCs, Kevin Li, MD, et al., used administrative claims data to look at 95,492 adults who underwent elective PCI for stable ischemic heart disease in the hospital outpatient department vs. 849 in the ASC setting, from 2007 to 2016.

Results showed in unmatched, multivariate analysis, PCI in the ASC setting was associated with increased odds of the primary outcome – a composite of 30-day myocardial infarction, bleeding complications and hospital admission – (odds ratio [OR]: 1.25; 95% CI: 1.01 to 1.56; p=0.039), and bleeding complications as an individual outcome (OR: 1.80; 95% CI: 1.11 to 2.90; p=0.016).

However, in propensity-matched analysis, PCI in the ASC setting was not associated with the primary outcome (OR: 1.23; 95% CI: 0.94 to 1.60; p=0.124), but was "significantly associated with increased bleeding complications" (OR: 2.49; 95% CI: 1.25 to 4.95; p=0.009). In addition, PCI in the ASC setting was associated with decreased fractional flow reserve utilization (OR: 0.31; 95% confidence interval [CI]: 0.20 to 0.48; p < 0.001).

The authors conclude that their finding of increased bleeding complications supports "the need for risk stratification prior to treating patients in the freestanding setting."

In a related editorial comment, Gregory J. Dehmer, MD, MACC, notes that "Allowing PCIs to be performed in ASCs is a logical extension of current practice that has potential for saving health care dollars." However, he cautions that "performing PCI in an ASC environment requires strict adherence to regulatory requirements and operational recommendations. Moreover, it is essential that data specific to the ASC environment be collected to evaluate the safety, effectiveness, and cost savings of this approach."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: AHA Annual Scientific Sessions, AHA20, Odds Ratio, Cost Savings, Confidence Intervals, Percutaneous Coronary Intervention, Multivariate Analysis, Outpatients, Medicare, Ambulatory Surgical Procedures, Fractional Flow Reserve, Myocardial, Medicaid, Myocardial Infarction, Myocardial Ischemia, Elective Surgical Procedures, Protein C Inhibitor

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