title: Kentucky pilot project for primary PCI without onsite CABG.
abstract: OBJECTIVE
  The American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions strongly recommend that primary Percutaneous Coronary Intervention (PCI) should be performed in facilities that have an experienced cardiovascular surgical team available as emergency backup for all procedures. The current study investigates the medical soundness of allowing select facilities in Kentucky to perform primary PCI despite being devoid of onsite emergency backup capabilities.
  
  
  METHODS
  Two hospitals in the state of Kentucky, currently without emergency backup capabilities, have been allowed to perform primary PCIs for more than three years (beginning in April 2005) by the Kentucky Cabinet for Health and Family Services. The two hospitals selected were of similar size (approximately 200 beds) and similar distances from hospitals with onsite emergency backup capabilities (approximately one hour). We performed an analysis evaluating if hospitals without backup surgical capability have similar outcomes when compared to hospitals with backup surgical capabilities. Outcome variables included: (1) mortality, (2) cardiac arrest as result of PCI, (3) emergency surgery performed as a result of PCI, and (4) door-to-balloon time.
  
  
  RESULTS
  Our results suggest that there is no significant difference in any of the outcome variables studied between facilities with and without onsite emergency backup capabilities.
  
  
  CONCLUSIONS
  Recommendations concerning primary PCI may need to be revisited. The principal outcomes associated with primary PCI were not significantly affected by whether a facility has onsite emergency backup capabilities. Therefore, we recommend that hospitals without backup surgical capabilities be allowed to perform primary PCI (with restrictions based on surgeon experience and the facilities' volume).
authors.affiliation: University of Louisville, School of Public Health and Information Sciences, Department of Bioinformatics and Biostatistics, 485 East Gray Street, Louisville, KY 40292, USA. john.myers@louisville.edu
authors.forename: John
authors.initials: J
authors.lastname: Myers
authors.forename: Guy
authors.initials: G
authors.lastname: Brock
authors.forename: Savitri
authors.initials: S
authors.lastname: Appana
authors.forename: Laman
authors.initials: L
authors.lastname: Gray
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D002315:Cardiopulmonary Bypass; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D010865:Pilot Projects