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Angioplasty experiment gets OK for UPMC McKeesport

| Friday, Jan. 16, 2009

UPMC McKeesport has joined a nationwide clinical trial that could reverse laws prohibiting community hospitals from performing a common elective procedure to reduce the risk of heart attack.

UMPC officials announced Thursday that the McKeesport hospital received permission from the state to perform elective angioplasties, which under Pennsylvania law must be done at hospitals with equipment and surgical teams capable of responding to cardiac emergencies.

"The whole point of this study is to prove that this is safe," said Dr. Stephen Bowser, medical director at the UPMC McKeesport Cardiac Catheterization Lab. "If, at the end of this trial, it is proven that doing (angioplasties) at community hospitals is as safe as at tertiary-care hospitals, then you're going to start seeing it offered at the larger community hospitals."

An angioplasty widens a blocked blood vessel to the heart.

When angioplasties first were introduced in the late 1970s, nearly one in 10 resulted in complications requiring emergency cardiac surgery, so doctors would only do them in hospitals capable of performing open-heart surgery, said Dr. Joon Sup Lee, clinical director of the UPMC Cardiovascular Institute. The complication rate has since dropped to one in 200.

"Whether it can be done safely in a setting without cardiac surgery on site is an open question in the cardiac community," Lee said. "But because of advances in technology, a lot of people believe that, with the right safeguards and controls, it can be done safely for patients who desire not to travel to a tertiary hospital."

The clinical trial run by Johns Hopkins Medical Institutions seeks to enroll 18,300 patients nationwide at hospitals such as UPMC McKeesport. Seventy-five percent of those patients would be treated at the community hospital, while the other 25 percent would be sent to the tertiary care hospital as a control group.

Last year, UPMC doctors performed about 4,000 angioplasties at the health system's four hospitals with heart surgery capabilities -- Presbyterian, Mercy, Shadyside and Passavant. Bowser estimates that UPMC McKeesport could handle about 200 angioplasties a year.

If there was an emergency during an angioplasty at UPMC McKeesport, the patient would be transported to one of UPMC's tertiary care hospitals. The standard of care requires that the patient be in the operating room within 60 minutes.

"The reality is that even at Shadyside or Mercy, if something goes wrong that requires surgery in the middle of the night, it's still going to take up to 60 minutes to get everybody in the surgical team assembled," Bowser said.

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