National Scientific Study and New Guidelines
Focus on Elective Coronary Angioplasty

Crestwood Medical Center is the Only Alabama Participant in Nationally Presented Research Trial that Confirms the Safety of Elective Angioplasty at Hospitals without Open Heart Surgery Programs

Two major scientific announcements this month strongly support Crestwood Medical Center’s plans to continue providing elective percutaneous coronary intervention (PCI) services, more commonly known as angioplasty. Crestwood has a Certificate of Need (CON) application pending before the Alabama CON Review Board, which, if approved, would allow the hospital to continue providing this important, life-saving procedure on an elective basis. The hospital has provided emergency angioplasty services for the past eight years, and for the past five years, it has safely and successfully performed elective angioplasty procedures under the rigorous safety standards of a national study known as the Atlantic C-PORT trials.

C-PORT Trials Demonstrate Safety of Elective Angioplasty at Hospitals Without Cardiac Surgery Capability

Results of the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT) trials were released this week. Sponsored by Johns Hopkins Medical Institutes, the C-PORT trials used a scientifically based, randomized research method to determine whether elective PCI can be safely performed in hospitals that do not offer open-heart surgery on site.

Since 2006, Crestwood, along with its team of board certified interventional cardiologists, has been performing elective angioplasty through its participation in the C-PORT trials, sponsored by John Hopkins Medical Institutions. Due to its successful outcomes with emergent PCIs, Crestwood was one of only 35 hospitals in the nation and the only hospital in Alabama selected to participate in the Atlantic C-PORT trials for elective PCI services. Crestwood is also one of the first hospitals in the state to report a consistent door-to-balloon time of less than 90 minutes and currently consistently averages approximately 72 minutes.

At the American Heart Association’s Scientific Sessions 2011 in Orlando this week, cardiologist Thomas Aversano, MD, who led the Johns Hopkins Medical Institutions study, presented the initial results of C-PORT trials which include the following study highlight:

• Patients who had non-emergency artery-opening angioplasty or stent implantation at hospitals without heart surgery capabilities fared as well as those in hospitals that did.

Crestwood Medical Center is continuing its participation in the C-PORT study, which is in the registry phase.

New ACC Guidelines Validate Safety of Elective PCI at hospitals like Crestwood

Also this month, the Journal of the American College of Cardiology released its 2011 guidelines for hospitals without on-site cardiac surgery:

• Primary PCI is reasonable in hospitals without on-site cardiac surgery, provided that appropriate planning for program development has been accomplished.

Crestwood Medical Center has requested a Certificate of Need (CON) from the Alabama State Certificate of Need Review Board to permanently establish elective percutaneous coronary intervention (PCI) services in addition to its existing diagnostic cardiac catheterization and emergency PCI services. This is the last step in obtaining full approval from the state to continue providing this service.   On June 10, 2011, the Statewide Health Coordinating Council voted to adopt Crestwood’s adjustment to the State Health Plan to allow the continuation of elective PCI on a permanent basis.  Governor Bentley approved the adjustment on June 14, 2011.

Currently, there is a provision under Alabama’s Certificate of Need Law that allows rural hospitals that do not have on-site cardiac surgery to perform elective angioplasty.  The hospitals that have utilized this exemption to provide elective angioplasty include Baptist Medical Center-Walker County, Cullman Regional Medical Center, DeKalb Regional Medical Center, George H. Lanier Memorial Hospital (Chambers County), Marshall Medical Center-North (Marshall County), Russell Hospital (Tallapoosa County), and Vaughn Regional Medical Center-Parkway (Dallas County).

Dr. Pam Hudson, Crestwood CEO, stated, “We are very pleased that, as expected, the initial reported results of the C-PORT trials and the guidelines from the American College of Cardiology confirm that community hospitals like Crestwood, who provide quality cardiac care with excellent patient outcomes, should be able to perform elective angioplasty. This is compelling and convincing scientific evidence that supports our efforts. There is no medically plausible reason anyone should oppose our CON. I congratulate our team of cardiologists and cardiac care nurses and technicians for their hard work and dedication in providing quality patient care.”

See recent articles on this subject in USA Today and The Washington Post.

Journal of the American College of Cardiology - 2011 PCI Guidelines