Elective percutaneous coronary intervention without on-site surgical backup: a community hospital experience
Djelmami-Hani M, Mouanoutoua M, Hashim A, et al. Elective percutaneous coronary intervention without on-site surgical backup: a community hospital experience. WMJ. 2007 Dec;106(8):481-5.
CONTEXT: The American College of Cardiology guidelines consider elective percutaneous coronary intervention (PCI) without on-site surgical backup (OSB) a Class-III indication.
OBJECTIVE: Our objective was to determine the safety of elective PCI without OSB.
DESIGN: The study is a prospective analysis of a cohort of patients who underwent elective PCI without OSB at our institution. All patients were at our community satellite institution in Beloit, Wis. Three hundred twenty-one elective interventions were performed (mean age 64 +/-12, 68% male). The prevalence of diabetes and hypertension was 28% and 82.5% respectively.
INTERVENTION: A predefined protocol was designed to transfer patients to a cardiac surgical facility if necessary. An experienced interventional cardiologist reviewed the diagnostic angiograms. Patients with complex lesions were excluded from the study.
MAIN OUTCOME MEASURE: Any procedure-related death or emergency coronary artery bypass graft surgery.
RESULTS: Three hundred eighty-two vessels were stented. Multi-vessel intervention was performed in 61 patients (19%). Only 5% of lesions were type C. Four hundred thirty-seven stents were deployed. IIb-IIIa inhibitors were used in 77 (24%) cases. Procedural success was 99.7%. There were no deaths, myocardial infarctions nor need for urgent target vessel revascularization at 6 months.
CONCLUSION: With careful patient/lesion selection, an experienced interventional cardiologist and a predefined transfer protocol, elective PCI without OSB can be performed safely.