Efficacy and safety of percutaneous coronary interventions in patients with non ST segment elevation acute coronary syndrome in catheterisation laboratory without on-site surgical back-up.
BACKGROUND
Percutaneous coronary intervention (PCI) in patients with non ST segment elevation acute coronary syndrome (NSTEACS) is regarded as a procedure which carries a high risk of immediate and long-term adverse cardiac events. This may potentially limit the use of PCI in catheterisation laboratories which do not have on-site surgical back up. However, stents and GP IIb/IIIa receptor inhibitors improved safety of interventional procedures.


OBJECTIVE
To analyse the immediate and long-term outcome of patients with NSTEACS in whom PCI was performed in a catheterisation laboratory without on-site surgical back-up in.


METHODS
In a cohort of 479 consecutive patients (160 with NSTEACS - group A, 319 with stable angina - group B) we analysed short and long-term clinical outcome of PCI performed in our catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time <30 minutes.


RESULTS
Stent implantation rate and the usage of GP IIb/IIIa blockers were higher in group A than in group B (61.3% vs 50.2%, p=0.04, and 17.5% vs 6.3%; p<0.001, respectively). The in- hospital outcome was similar in both groups (death: 0.6 vs 0.6%; myocardial infarction (MI): 2.5 vs 1.6%; and urgent reintervention (rePCI): 1.9 vs 1.3%, all differences NS). Acute PCI complications requiring urgent surgical operation occurred in 1 (0.6%) patient from group A and in 1 (0.3%) patient from group B (NS). Both patients were successfully transferred for cardiac surgery. During a long-term follow-up the incidence of death (2.0 vs 2.0%), MI (0.7 vs 0.7%), rePCI (21.8 vs 25.2%), CABG (1.4 vs 1.4%) or coronary rehospitalisation (5.4 vs 7.7%) was similar in both groups. The Kaplan-Meier survival and event-free curves were parallel.


CONCLUSIONS
In the era of coronary stents and platelet GP IIb/IIIa receptor inhibitors the short and long-term outcome after PCI in patients with NESTACS and stable angina is similar. The early aggressive approach to patients with NESTACS is feasible and safe in a catheterisation laboratory without on-site cardiac surgery. Surgical back-up is still necessary for only few PCI complications.
Dudek
Dariusz
D
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University College of Medicine, Cracow, Poland.
Rakowski
Tomasz
T
Legutko
Jacek
J
Mielecki
Waldemar
W
Dziewierz
Artur
A
Bartuś
Stanisław
S
Rzeszutko
Łukasz
Ł
Sadowski
Jerzy
J
Zmudka
Krzysztof
K
Dubiel
Jacek S
JS
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents / Q000706:statistics & numerical data; D015996:Survival Rate; D013577:Syndrome; D016896:Treatment Outcome