Key takeaways:
- Thirty-day PCI outcomes have been comparable at ASCs in contrast with hospitals.
- ASCs conferred extra repeat procedures, however the the explanation why are unclear.
Sufferers who underwent PCI at an ambulatory surgical procedure heart had comparable security outcomes as those that had their process in a hospital, researchers reported on the Society for Cardiovascular Angiography and Interventions Scientific Periods.
Katerina Dangas, BMBCh, analysis fellow on the Smith Middle for Outcomes Analysis, Beth Israel Deaconess Medical Middle, introduced findings an evaluation of Medicare claims evaluating procedural quantity tendencies, affected person and process traits and 30-day outcomes between PCI carried out at hospitals vs. ASCs.
Thirty-day PCI outcomes have been comparable at ASCs in contrast with hospitals. Picture: Adobe Inventory
ASCs present lower-cost procedures to lower-risk sufferers, Dangas mentioned throughout a press convention.
The proportion of PCI procedures carried out at ASCs has grown since 2020, when CMS started reimbursing for PCI carried out there, Dangas mentioned in the course of the press convention.
“However, the proof base for ASC PCI is exceedingly skinny,” she mentioned. “We sought to start to shut this hole.”
The variety of PCI procedures per 10,000 Medicare beneficiaries at hospitals was 36.57 in 2018 and 33.15 in 2022, whereas for ASCs it was 0.01 in 2018 and 0.87 in 2022, she mentioned.
In contrast with sufferers from hospitals, sufferers from ASCs have been extra more likely to be from the South (66.1% vs. 44.5%) or the West (20% vs. 15.6%) and from essentially the most weak populations (36.6% vs. 21.9%). “What this would possibly counsel is that ASCs could attain underserved populations,” Dangas mentioned.
The ASC group was much less seemingly than the hospital group to have had acute MI inside 1 yr of their process (2.7% vs. 6%), she mentioned.
Extra advanced procedures have been much less widespread in ASCs than in hospitals, she mentioned, noting that procedures at ASCs have been much less more likely to contain atherectomy (2.4% vs. 6.8%), IVUS or fractional movement reserve (12.8% vs. 35.4%) or multivessel PCI (3% vs. 5.9%) than these at hospitals.
“That is seemingly associated to the truth that in the course of the research interval, Medicare didn’t reimburse” for atherectomy, IVUS or FFR in ASCs, Dangas mentioned.
She mentioned the next 30-day outcomes have been rare in each places: all-cause dying (hospital, 0.7%; ASC, 0.55%), acute MI (hospital, 1.6%; ASC, 0.9%), stroke (hospital, 0.3%; ASC, 0.27%) and pericardial effusion/tamponade (hospital, 0.2%; ASC, 0%).
There have been additionally no variations in access-site bleeding (hospital, 0.8%; ASC, 0.66%) and transfusions (hospital, 0.7%; ASC, 0.46%), Dangas mentioned.
Nevertheless, at 30 days, in contrast with sufferers who had their PCI at a hospital, those that had it at an ASC have been much less more likely to require a hospital admission for any trigger (5.47% vs. 8.9%) however extra more likely to want a repeat process (9.99% vs. 4.7%), she mentioned.
For the repeat process discovering, “in claims information we’re unable to reliably differentiate between therapy failure and staged revascularization procedures,” she mentioned. “This may should be additional investigated. Our findings are reassuring, however should be validated in datasets which are nationally consultant of all payers and embrace traits that we weren’t in a position to account for right here, most significantly, procedural indication, angiographic danger, symptom severity and medicine adherence.”
Sources/Disclosures
Collapse
Dangas Okay, et al. Featured medical analysis. Offered at: Society for Cardiovascular Angiography and Interventions Scientific Periods; Could 1-3, 2025; Washington, D.C.
Disclosures:
Dangas stories no related monetary disclosures.
