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Surgical backup needed for non-urgent angioplasties

Patients undergoing non-emergency angioplasty in medical centres where surgical backup was not available were twice as likely to die, a study presented last week at the American Heart Association's scientific sessions in New Orleans showed. Patients were also 20% more likely to require bypass surgery elsewhere, the study found. 
 
Percutaneous transluminal coronary angioplasty was introduced in the early 1980s, when it was performed only in hospitals that had onsite, backup surgical teams in case something went wrong. The procedure is now often carried out in units where no such team is available. This has led to controversy over whether the lack of a backup team increases the risk of life threatening complications. 
 
"This study should serve as a cautionary flag," said Dr David Wennberg, director of the centre for outcomes research and evaluation at Maine Medical Centre, Portland, Maine, who is also the study's lead investigator. He continued: "While single-institution reports have suggested that performing angioplasty without surgical backup is a safe procedure, our data suggest that does not hold true when you look at medical centres and hospitals across the United States." 
 
The importance of a backup team depends on the reason the angioplasty is being done. His study compared more than 2500 angioplasties performed in 1996 and 1997 in 198 institutions across the country without surgical backup with about 365 000 performed in units where there was such a backup. 
 
Patients in the study were in the Medicare programme, which provides health insurance coverage to people aged over 65. 
 
The researchers found that when an emergency angioplasty was performed either at the time of a heart attack or when drugs failed to dissolve a blockage, the lack of a backup made no difference to the outcome of the operations. But when patients were undergoing non-emergency angioplasty, they were much more likely to die or to need another operation elsewhere if no backup team was available. The researchers plan to undertake further studies aimed at understanding why this is so.