Percutaneous transluminal coronary angioplasty without on-site surgical facilities.
Percutaneous transluminal coronary angioplasty (PTCA) is associated with a low risk of serious complications, the most important of which is acute coronary occlusion needing emergency surgery. There is a consensus among many cardiologists and cardiac surgeons that all PTCA procedures need on-site surgical backup. A task force report on PTCA by the American College of Cardiology/American Heart Association mandates the presence of an on-site cardiovascular surgical team. Since 1981, we have performed PTCA without the benefit of on-site surgery but with backup surgery provided at a regional cardiac surgical center located 6 kilometers away. Up to the end of 1991, 762 patients have undergone 847 PTCAs. Most patients had 1-vessel angioplasty (94.6%). The primary success rate since 1981 was 76%, and from January 1990 to December 1991 it was 87% (n = 313). Complications included death in 7 patients (0.9%), myocardial infarction in 16 (2.1%) and emergency surgery in 12 (1.6%). Surgical backup was provided on a next available operating room basis. The average time from decision to transfer to onset of surgery was 164 minutes (range 75 to 320). All patients survived surgery, but 42% developed a new Q-wave myocardial infarction. These patients were followed up until the end of 1991, and are all alive. The results are similar to those reported from centers with and without on-site surgery. With careful selection of patients and a formal, coordinated plan for backup surgery, PTCA can be safely performed without on-site surgery.
Klinke
W P
WP
Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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D000416:Alberta; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016507:Cardiology Service, Hospital; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery; D009873:Operating Rooms; D012307:Risk Factors; D013997:Time Factors; D014187:Transportation of Patients