Emergency cardiac surgery after a failed percutaneous coronary intervention in an interventional centre without on-site cardiac surgery

Lemkes, Jorrit S.; Peels, J.O.J.; Huybregts, Rien A.J.M.; Swart, Hans de; Hautvast, Raymond W.M.; Umans, Victor

doi:10.1007/bf03085976

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…With the improvement in catheter technique, experienced operators and the development of new devices, overall complication rates of PCI are low and emergency cardiac surgery rates resulting from PCI procedure are at 0.2%. 6 Wu and colleagues, 7 showed in-hospital mortality of 1.8% while in our study the in-hospital mortality was 4.9%. A slightly higher mortality in our study may be secondary to higher number of patients with STEMI.…”

Section: Discussioncontrasting

confidence: 53%

Percutaneous Coronary Intervention without onsite Cardiac Surgery Backup

et al. 2013

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Introduction: Mechanical revascularization by percutaneous coronary interventions has now become an established and preferable method of revascularization in patients with acute coronary syndromes. The aim of the study was to identify the clinical indications for percutaneous coronary interventions and in-hospital outcomes of percutaneous coronary interventions in a tertiary-level hospital without onsite cardiac surgery backup. Methods: This was a prospective descriptive study. All consecutive patients who were admitted for percutaneous coronary interventions, including both primary as well as elective percutaneous coronary interventions, between March 2011 and December 2012 were included in the study. Results: Total 101 percutaneous coronary interventions were performed. The mean age was 58.9 ± 12.3 years. The most frequent indication was ST-elevation myocardial infarction 72 (71.3%). Proximal artery stenting were performed in 39 (38.5%) and the non proximal artery stenting in 62 (61.5%). The outcomes were mortality 5 (4.9%), periprocedural myocardial infarction 2 (1.9%), cardiogenic shock 6 (5.9%), contrast induced nephropathy requiring dialysis in 3 (2.9%), minor complications which were managed conservatively in 13 (12.9%). Conclusions: Percutaneous coronary intervention was feasible with acceptable complications in a tertiary-level hospital without onsite cardiac surgery backup. ST-elevation myocardial infarction was the major indication and cardiogenic shock was the major complication observed, and non proximal artery stenting was more common than the proximal artery stenting. Keywords: indication; onsite cardiac surgery; outcomes; percutaneous coronary interventions.

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Section: Discussioncontrasting

confidence: 53%

Percutaneous Coronary Intervention without onsite Cardiac Surgery Backup

et al. 2013

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“…The need for bail-out surgery after on-site PCI has dropped dramatically in the past decades, from 6.6 % in the initial years to 0.3–0.6 % currently [ 15 , 16 ]. The mortality rates for patients requiring emergency surgery are the same in off-site and on-site PPCI centres [ 17 , 18 ]. The European Society of Cardiology (ESC) recommends (Ib) PPCI to be performed by experienced operators in a 24-hour/7-day service [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup

et al. 2016

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ObjectivesTo evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands.BackgroundControversy remains about the safety and efficacy of PPCI in off-site PCI centres.MethodsWe retrospectively analysed clinical and procedural data as well as 6‑month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven.ResultsPPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4 % VieCuri vs. 12.3 % Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9 %) patients in the VieCuri group and 9 (8.1 %) in the Catharina Hospital group had a major adverse cardiac event.ConclusionPerforming PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.

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“…It describes the performance of emergency surgery after failed PCI in an interventional centre without on-site cardiac surgery. 1 This certainly strengthens the position of the proponents of the feasibility of high-quality PCI programmes without on-site cardiac surgery. However, we have to bear in mind that these data only provide a single piece of a rather complex jigsaw puzzle.…”

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confidence: 58%