Erik Swain , 2025-05-08 14:00:00
Key takeaways:
- Thirty-day PCI outcomes were similar at ASCs compared with hospitals.
- ASCs conferred more repeat procedures, but the reasons why are unclear.
Patients who underwent PCI at an ambulatory surgery center had similar safety outcomes as those who had their procedure in a hospital, researchers reported at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Katerina Dangas, BMBCh, research fellow at the Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, presented findings an analysis of Medicare claims comparing procedural volume trends, patient and procedure characteristics and 30-day outcomes between PCI performed at hospitals vs. ASCs.
Thirty-day PCI outcomes were similar at ASCs compared with hospitals. Image: Adobe Stock
ASCs provide lower-cost procedures to lower-risk patients, Dangas said during a press conference.
The proportion of PCI procedures performed at ASCs has grown since 2020, when CMS began reimbursing for PCI performed there, Dangas said during the press conference.
“Nevertheless, the evidence base for ASC PCI is exceedingly thin,” she said. “We sought to begin to close this gap.”
The number 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 said.
Compared with patients from hospitals, patients from ASCs were more likely to be from the South (66.1% vs. 44.5%) or the West (20% vs. 15.6%) and from the most vulnerable populations (36.6% vs. 21.9%). “What this might suggest is that ASCs may reach underserved populations,” Dangas said.
The ASC group was less likely than the hospital group to have had acute MI within 1 year of their procedure (2.7% vs. 6%), she said.
More complex procedures were less common in ASCs than in hospitals, she said, noting that procedures at ASCs were less likely to involve atherectomy (2.4% vs. 6.8%), IVUS or fractional flow reserve (12.8% vs. 35.4%) or multivessel PCI (3% vs. 5.9%) than those at hospitals.
“This is likely related to the fact that during the study period, Medicare didn’t reimburse” for atherectomy, IVUS or FFR in ASCs, Dangas said.
She said the following 30-day outcomes were infrequent in both locations: all-cause death (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 were also no differences in access-site bleeding (hospital, 0.8%; ASC, 0.66%) and transfusions (hospital, 0.7%; ASC, 0.46%), Dangas said.
However, at 30 days, compared with patients who had their PCI at a hospital, those who had it at an ASC were less likely to require a hospital admission for any cause (5.47% vs. 8.9%) but more likely to need a repeat procedure (9.99% vs. 4.7%), she said.
For the repeat procedure finding, “in claims data we are unable to reliably differentiate between treatment failure and staged revascularization procedures,” she said. “This will need to be further investigated. Our findings are reassuring, but need to be validated in datasets that are nationally representative of all payers and include characteristics that we weren’t able to account for here, most importantly, procedural indication, angiographic risk, symptom severity and medication adherence.”
Sources/Disclosures
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Dangas K, et al. Featured clinical research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 1-3, 2025; Washington, D.C.
Disclosures:
Dangas reports no relevant financial disclosures.
