Patients who had a minimally-invasive heart procedure called PCI at U.S. hospitals without on-site cardiac surgery did as well as those who had the same procedure at institutions with surgical back-up, the results of a national study shows. In 2005, Tift Regional Medical Center (TRMC) was one of 10 Georgia hospitals selected to participate in the PCI national clinical trial called C-PORT, administered by Johns Hopkins Medical Institute in Baltimore.
PCI, which stands for Percutaneous Coronary Intervention, is a minimally-invasive stenting procedure used to unblock clogged arteries leading to the heart. PCI is also commonly referred to as angioplasty.
In the C-PORT (Cardiovascular Patient Outcomes Research Team) study, more than 18,500 patients nationwide were randomized on a three-to-one basis to PCI centers without cardiac-surgery capabilities or hospitals with surgical backup. The 60 institutions without surgery capabilities, including TRMC, had to be able to perform at least 200 PCIs per year, although a "start-up" figure of 100 was allowed in the first year, with a median of 150 annual procedures.
The mortality rate after six weeks was almost the same for each group, at less than one percent, reported Dr. Thomas Aversano with Johns Hopkins Medical Institute, who presented the findings of the C-PORT study to the American Heart Association (AHA) 2011 Scientific Sessions in November.
“The trial demonstrated, as found in other studies, that hospitals can safely perform angioplasty procedures without having open-heart surgery as a back-up measure in case of complications,” said Dr. Paul Murray, an interventional cardiologist on the TRMC medical staff. “Hospitals like Tift Regional have the best life-saving therapy available for heart attacks, and now with the results of this study confirming what we already knew, we’ll be able to continue to fully utilize it for elective and emergency procedures.”
Prior to the trial being approved, only hospitals in Georgia with on-site open heart surgery centers could perform angioplasties.
“Angioplasty has been established as an effective procedure in correcting diseased arteries, the cause of heart attacks and severe chest pain,” said Dr. Murray. “But, the state’s standards had really penalized residents who live in rural areas, because most hospitals serving these communities don’t have on-site open heart surgery programs.”
Those in rural areas had to travel quite a distance to receive treatment.
Cardiologist Dr. William Hancock, also on the TRMC medical staff, said, “This created significant inconvenience for patients and their families as well as added delay, increased costs and greater health risk. And, in many cases, it could be a matter of life or death. Every rural hospital has stories of heart attack victims being sent out-of-town to bigger hospitals, with some dying on the way.”
As one of the study’s requirements, TRMC had to transfer one-in-four patients to a cardiovascular facility that has an open heart surgery program. Now, with the C-PORT study concluded, all patients referred to TRMC for PCI can remain locally for treatment.
“This is great news for residents of South Central Georgia, and this will significantly improve access to heart care,” said Dr. Hancock.
The TRMC Heart and Vascular Center continues to grow with the addition of a third cardiologist and second interventionalist, Dr. Jonathan Tronolone, who comes to the community after practicing in Augusta. TRMC also recently initiated an $8.9 million expansion and renovation of the Heart and Vascular Center, to include the addition of a third cardiac catheterization laboratory, renovation of the current angiography laboratory, new post procedure rooms and expansion of cardiopulmonary rehabilitation, nuclear medicine, stress testing and work areas.
“I was impressed that TRMC was a part of the C-PORT trial and is now able to perform both elective and emergent angioplasty,” said Dr. Tronolone. “That is what attracted me to this opportunity. I look forward to working with Dr. Murray and Dr. Hancock in helping this heart program continue to grow and meet the needs of the region.”