Nonemergent coronary angioplasty without on-site surgical backup: a randomized study evaluating outcomes in low-risk patients.
BACKGROUND
Percutaneous coronary intervention (PCI) in nonemergent patients with coronary artery disease in hospitals without on-site cardiac surgery backup is still controversial. To prospectively evaluate a set of low procedural risk criteria for PCI, patients with stable or unstable angina were randomized to treatment in either a community hospital, which had all supportive services except for on-site cardiac surgery, or a regional surgical hospital 213 km away.


RESULTS
During a 4-year period, 609 (57%) of 1064 consecutive patients with stable or unstable angina who underwent coronary angiography at a teaching community hospital in Norway fulfilled the predefined low-risk criteria for PCI. The patients were randomized to treatment at either the community hospital (n = 305) or at the regional hospital (n = 304). The angiographic success rate (96% at both hospitals) and number of major periprocedural complications (overall 0.3%) were equal at the 2 hospitals. In particular, there were no deaths or need for urgent transfer to cardiac surgery. At 6 months of clinical follow-up, there was a significant higher major adverse cardiac event rate rate at the community hospital, compared with the regional hospital (6.9% vs 2.3%, respectively, P = .03) because of more repeat target vessel revascularizations. Improvement in angina functional class and exercise capacity was similar in both groups. The excluded high-risk PCI patients had higher 6-month major adverse cardiac event compared with all low-risk patients (8.4% vs 4.3%, respectively, P = .01).


CONCLUSIONS
Selected nonemergent patients can, based on angiography, safely undergo PCI at hospitals without cardiac surgery backup. The angiographic selection criteria identified high-risk patients, which had worsened outcome at 6 months of follow-up.
Melberg
Tor
T
Division of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Nilsen
Dennis W T
DW
Larsen
Alf Inge
AI
Barvik
Ståle
S
Bonarjee
Vernon
V
Kuiper
Karel K-J
KK
Nordrehaug
Jan Erik
JE
D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006348:Cardiac Surgical Procedures; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy; D017558:Elective Surgical Procedures; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome