Elective percutaneous coronary intervention without on-site surgical backup: a community hospital experience.
BACKGROUND
The American College of Cardiology guidelines consider elective percutaneous coronary intervention (PCI) without on-site surgical backup (OSB) a Class-III indication.


OBJECTIVE
Our objective was to determine the safety of elective PCI without OSB.


METHODS
The study is a prospective analysis of a cohort of patients who underwent elective PCI without OSB at our institution. All patients were at our community satellite institution in Beloit, Wis. Three hundred twenty-one elective interventions were performed (mean age 64 +/-12, 68% male). The prevalence of diabetes and hypertension was 28% and 82.5% respectively.


METHODS
A predefined protocol was designed to transfer patients to a cardiac surgical facility if necessary. An experienced interventional cardiologist reviewed the diagnostic angiograms. Patients with complex lesions were excluded from the study.


METHODS
Any procedure-related death or emergency coronary artery bypass graft surgery.


RESULTS
Three hundred eighty-two vessels were stented. Multi-vessel intervention was performed in 61 patients (19%). Only 5% of lesions were type C. Four hundred thirty-seven stents were deployed. IIb-IIIa inhibitors were used in 77 (24%) cases. Procedural success was 99.7%. There were no deaths, myocardial infarctions nor need for urgent target vessel revascularization at 6 months.


CONCLUSIONS
With careful patient/lesion selection, an experienced interventional cardiologist and a predefined transfer protocol, elective PCI without OSB can be performed safely.
Djelmami-Hani
M
M
Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wis, USA.
Mouanoutoua
Mouatou
M
Hashim
Abdelazim
A
Solis
Joaquin
J
Bergen
Lawrence
L
Oldridge
Neil
N
Egbujiobi
Leo C
LC
Allaqaband
Suhail
S
Akhtar
Masood
M
Bajwa
Tanvir
T
D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D014922:Wisconsin