title: A total of 1,007 percutaneous coronary interventions without onsite cardiac surgery: acute and long-term outcomes.
abstract: OBJECTIVE
  We sought to compare clinical outcomes of elective percutaneous coronary intervention (PCI) and primary PCI for ST-segment elevation myocardial infarction (STEMI) at a community hospital without onsite cardiac surgery to those at a tertiary center with onsite cardiac surgery.
  
  
  BACKGROUND
  Disagreement exists about whether hospitals with cardiac catheterization laboratories, but without onsite cardiac surgery, should develop PCI programs. Primary PCI for STEMI at hospitals without onsite cardiac surgery have achieved satisfactory outcomes; however, elective PCI outcomes are not well defined.
  
  
  METHODS
  A total of 1,007 elective PCI and primary PCI procedures performed from March 1999 to August 2005 at the Immanuel St. Joseph's Hospital-Mayo Health System (ISJ) in Mankato, Minnesota, were matched one-to-one with those performed at St. Mary's Hospital (SMH) in Rochester, Minnesota. Strict protocols were followed for case selection and PCI program requirements. Clinical outcomes (in-hospital procedural success, death, any myocardial infarction, Q-wave myocardial infarction, and emergency coronary artery bypass surgery) and follow-up survival were compared between groups.
  
  
  RESULTS
  Among 722 elective PCIs, procedural success was 97% at ISJ compared with 95% at SMH (p = 0.046). Among 285 primary PCIs for STEMI, procedural success was 93% at ISJ and 96% at SMH (p = 0.085). No patients at ISJ undergoing PCI required emergent transfer for cardiac surgery. Survival at two years' follow-up by treatment location was similar for patients with elective PCI and primary PCI.
  
  
  CONCLUSIONS
  Similar clinical outcomes for elective PCI and primary PCI were achieved at a community hospital without onsite cardiac surgery compared with those at a tertiary center with onsite cardiac surgery using a prospective, rigorous protocol for case selection and PCI program requirements.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. ting.henry@mayo.edu
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raveendran
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Kirsten Hall
authors.initials: KH
authors.lastname: Long
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Wood
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D013997:Time Factors; D016896:Treatment Outcome