Current state of the performance of percutaneous coronary intervention in centres without on‐site cardiac surgery

Abstract

Before the routine use of coronary stents, potential complications of percutaneous coronary interventions required the presence of backup cardiac surgery on-site. Advances in pharmacotherapy and interventional techniques, particularly in the last decade, have significantly decreased the rates of complications requiring emergency cardiac surgery, from approximately 4% to 6% in the balloon angioplasty era to as low as 0.3% to 0.6% in the contemporary era of routine intracoronary stent implantation.An early invasive approach has been shown to improve outcomes among patients with non-ST elevation acute coronary syndromes (NSTEACS), particularly in those at the highest risk, emphasising the importance of early access to revascularisation premises in such patients.Patients with ST-segment elevation myocardial infarction require immediate and sustained recanalisation of the culprit vessel to obtain rapid reperfusion of the threatened myocardium, in order to reduce infarct size and improve outcomes.Primary percutaneous coronary intervention at hospitals without on-site cardiac surgery improves clinical outcomes and reduces length of stay when compared with fibrinolytic therapy. It also significantly reduces door-to-balloon times when compared with transfer for percutaneous coronary interventions at hospitals with on-site surgery.It has been published that risk-adjusted mortality rates for patients undergoing percutaneous coronary interventions in centres without on-site surgical backup are comparable with those of percutaneous coronary intervention facilities that have cardiac surgery on-site, regardless of whether percutaneous coronary intervention was performed as primary therapy for ST-segment elevation myocardial infarction or in a non-primary setting. To achieve these results however, an adequate percutaneous coronary intervention programme is required, including proper hospital infrastructure and appropriately trained interventional cardiologists.bs_bs_banner Thornley et al.

Coronary artery bypass graft surgery for right coronary artery: balloon catheter entrapment

“…In the recent literature, the complication rates of PCI requiring emergency cardiac surgery have been decreased from approximately 6-4% to as low as 0.6-0.3% with the advancements in the interventional techniques. [1] Primary PCIs are considered to be reasonable in hospitals without on-site cardiac surgery in accordance with the 2011 ACCF/AHA/SCAI (American College of Cardiology Foundation/American Heart Association/Society for Cardiovascular Angiography and Interventions) PCI Guidelines (Class IIa, level of evidence B) [2] Although the complication rates requiring surgery are low, it cannot be excluded totally. Therefore, current guidelines may be questioned for the present suggestions.…”