Low-risk percutaneous coronary interventions without on-site cardiac surgery: two years' observational experience and follow-up.
BACKGROUND
We studied the safety and efficacy of performing low-risk elective and acute infarct percutaneous coronary interventions at a community hospital without cardiac surgical capability.


METHODS
Immanuel St Joseph's Hospital is located 85 miles from St Mary's Hospital, which is the nearest center with on-site cardiac surgery. All components of the Mayo Clinic percutaneous coronary intervention program were replicated at Immanuel St Joseph's Hospital, including a telemedicine system to enable real-time consultation with interventional and cardiac surgical colleagues during procedures.


RESULTS
From March 1999 to June 2001, 196 patients underwent elective percutaneous coronary intervention at Immanuel St Joseph's Hospital. Procedural success was achieved in 195 (99.5%) patients, with 1 (0.5%) inhospital death. At mean follow-up of 8.2 months, 2 (1.0%) additional patients died of noncardiac causes and 15 (7.7%) patients required target vessel revascularization. From March 2000 to June 2001, 89 patients underwent primary percutaneous coronary intervention for acute myocardial infarction. Procedural success was achieved in 83 (93.3%) patients, with 3 (3.4%) inhospital deaths. At 30-day follow up, no additional patients died, had recurrent myocardial infarction, or required target vessel revascularization. No patients required transfer to another facility for emergent cardiac surgery for a procedure-related complication.


CONCLUSIONS
Low-risk elective and acute infarct percutaneous coronary interventions can be performed with safety and efficacy at a community hospital without cardiac surgical capability by following rigorous standards.
Ting
Henry H
HH
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. ting.henry@mayo.edu
Garratt
Kirk N
KN
Singh
Mandeep
M
Kjelsberg
Michael A
MA
Timimi
Farris K
FK
Cragun
Kevin T
KT
Houlihan
Robert J
RJ
Boutchee
Katherine L
KL
Crocker
Christopher H
CH
Cusma
Jack T
JT
Wood
Douglas L
DL
Holmes
David R
DR
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards*; D016507:Cardiology Service, Hospital / Q000458:organization & administration / Q000592:standards*; D002423:Cause of Death; D017023:Coronary Angiography; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000628:therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012306:Risk; D012449:Safety; D017216:Telemedicine; D016896:Treatment Outcome