title: Three-year experience of primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction in a hospital without on-site cardiac surgery.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in hospitals without on-site cardiac surgery capability, despite receiving only a class IIb recommendation in the ACC/AHA practice guidelines, can be performed effectively and safely. We reviewed the fi rst 3 years of our experience.
  
  
  METHODS
  This is a retrospective single centre review of all patients receiving primary PCI for STEMI between 2003 and 2005. Demographic, procedural and outcome data were analysed.
  
  
  RESULTS
  There were 259 patients who underwent primary PCI. The mean age was 55.3 +/- 12.3 years. Median door-to-balloon time was 97.5 minutes and 45.2% and 52.9% had anterior and inferior STEMI, respectively. The majority of patients presented with Killip class I (87.6%); however, 5.8% were in Killip class IV. Single vessel disease was found in 47.1%. Angiographic PCI success (defined as residual stenosis <50% with TIMI 3 fl ow) was achieved in 89.1%. Usage of stents, distal protection and aspiration devices were 97.2%, 27.8% and 34.1 %, respectively; 9.3% required intra-aortic balloon pump insertion. No patients required transfer for emergency coronary bypass surgery as a result of PCI complications. Post-PCI ST resolution >50% was achieved in 80.6%. The mean post-infarct left ventricular ejection fraction was 44.1%. In-hospital, 30-day, 6-month and 1-year mortality rates were 2%, 2.8%, 4.0% and 4.8%, respectively. Clinically driven target lesion revascularisation rate was 2.8% at 1 year.
  
  
  CONCLUSIONS
  Our results are comparable to those from on-site surgical centres. This supports the feasibility and safety of primary PCI in cardiac centres without on-site cardiac surgery.
authors.affiliation: Department of Cardiology, Changi General Hospital, Singapore. seahing@gmail.com
authors.forename: Sea Hing
authors.initials: SH
authors.lastname: Ong
authors.forename: Victor Y T
authors.initials: VY
authors.lastname: Lim
authors.forename: Boon Cheng
authors.initials: BC
authors.lastname: Chang
authors.forename: Jayaram
authors.initials: J
authors.lastname: Lingamanaicker
authors.forename: Chong Hiok
authors.initials: CH
authors.lastname: Tan
authors.forename: Yew Seong
authors.initials: YS
authors.lastname: Goh
authors.forename: Kok Soon
authors.initials: KS
authors.lastname: Tan
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors