Keele Research Repository

Background Nonsurgical centres (NSCs) contribute to the significant capacity of overall PCI in the UK. Whilst previous studies have demonstrated similar PCI outcomes in surgical centres (SCs) vs NSCs, it is unknown whether this applies to more complex procedures such as LMS PCI. We compared patient characteristics and outcomes in left main stem (LMS) PCI performed across SCs vs NSCs in England and Wales. Methods A retrospective analysis of procedures between January 2006 and March 2020 was performed using the British Cardiovascular Intervention Society database and stratified according to the surgical status of the centre. The primary outcomes assessed were in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality and Bleeding Academic Research Consortium (BARC) stage 3-5 bleeding. Results 40,744 patients underwent LMS PCI during the period, of which 13,922 (34.2%) had their procedure performed at an NSC. The proportion of LMS PCI performed in NSCs increased by more than 2-fold (15.9% in 2006 to 36.7% in 2020). There was no association between surgical cover location and in-hospital mortality (OR 0.92, 95% CI 0.69-1.22), in-hospital MACCE (OR 1.00, 95% CI 0.79- 1.25), or emergency CABG (OR 1.00, 95% CI 0.95-1.06). NSCs had lower BARC 3-5 bleeding complications (OR 0.53, 95% CI 0.34-0.82). There has been an increase in LMS PCI volumes at NSCs, particularly elective LMS PCI. LMS PCI performed at NSCs was not associated with increased mortality, in-hospital MACCE, or emergency CABG, despite higher disease complexity.