Meta-analysis finds no mortality difference for PCI with surgical backup

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Angiology Published May 2, 2026 Medically reviewed May 8, 2026 Study authors: Haddad Tala A, Toubasi Ahmad A, Fahmawi Abdallah, Zaid Ali PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that surgical backup for PCI may not improve most outcomes but could increase emergency bypass and repeat procedures.

This meta-analysis evaluated outcomes for patients undergoing percutaneous coronary intervention in hospitals with surgical on-site backup compared to those without. The study pooled data from observational studies and clinical trials to assess 30-day mortality, myocardial infarction, cerebral vascular accident, emergency coronary artery bypass surgery, repeat PCI, and target vessel revascularization.

The authors observed no significant difference in 30-day mortality, myocardial infarction, cerebral vascular accident, or target vessel revascularization between settings. However, they reported increased rates of emergency bypass surgery and repeat PCI in hospitals with surgical backup. The analysis included a large patient population from multiple studies.

Key limitations noted by the authors include that the source is a meta-analysis of observational studies and clinical trials, not a primary trial. Subgroup analyses among clinical trials and STEMI patients found no significant associations. The certainty of evidence is based on pooled effect sizes from 22 studies, with no individual trial-level details reported.

Clinically, this meta-analysis provides updated insight into the impact of surgical backup on PCI outcomes, showing no difference in most outcomes except for increased emergency bypass and repeat PCI rates in hospitals with backup. The results show association, not causation, and should be interpreted cautiously in practice.

Study Details

Study typeMeta analysis

Sample sizen = 2,181,897

EvidenceLevel 1

PublishedMay 2026

PMID40114493

View Original Abstract ↓

Percutaneous coronary interventions (PCIs) have seen a steady rise. Recent guidelines have established that PCIs conducted at non-surgical on-site (NSOS) facilities have low complication rates and outcomes comparable to surgical on-site (SOS) centers. However, differing perspectives in the growing literature continue to sustain controversy. A thorough literature review was performed across four databases, including PubMed, Cochrane Library, Scopus, and Web of Science, to identify studies comparing outcomes between hospitals. The primary endpoints were: 30-day mortality, myocardial infarction (MI), cerebral vascular accident (CVA), emergency coronary artery bypass surgery (eCABG), rePCI, and target vessel revascularization (TVR). The final search yielded 22 studies, including a total of 2,181,897 patients. The majority of patients (71.9%) underwent PCI in SOS hospitals. There was a significant association of increased eCABG (OR = 1.99; 95% CI: 1.08-3.67) and rePCI (OR = 1.62; 95% CI: 1.37-1.91) rates in SOS hospitals. However, 30-day mortality (OR = 0.91; 95% CI: 0.53-1.54), MI (OR = 1.08; 95% CI: 0.91-1.28), CVA (OR = 1.13; 95% CI: 0.69-1.86), and TVR (OR = 1.06; 95% CI: 0.92-1.21) showed no significant difference between hospitals. Subgroup analyses among clinical trials and ST-segment elevation myocardial infarction (STEMI) patients found no significant associations. Conclusively, this meta-analysis provides updated insight into the impact of SOS on PCI outcomes, having no difference except for eCABG and rePCI rates.