October 27, 2004

Is Onsite Surgery Backup Necessary for Percutaneous Coronary Interventions?

Author Affiliations

Author Affiliation: Henry Ford Heart & Vascular Institute, Wayne State University, Detroit, Mich.

JAMA. 2004;292(16):2014-2016. doi:10.1001/jama.292.16.2014

The number of percutaneous coronary intervention (PCI) procedures performed each year has increased substantially, particularly since the introduction of coronary stents. The current increase is being fueled by the shift from thrombolysis to the performance of primary PCI for treatment of acute myocardial infarction (MI). Also, with the availability of drug-eluting stents, patients who previously would not have been eligible for PCI are now candidates for this intervention. The drive to treat patients with acute ST-elevation MI (STEMI) in a timely manner poses the question of whether many more moderate-sized and often suburban hospitals, which in most cases do not have cardiac surgery onsite, should provide primary PCI for patients with STEMI. On the surface, it seems unnecessary to provide surgical backup onsite in such programs because the need for emergency surgery for failed PCI for STEMI is small (1% or less).1,2 It would seem adequate to have an emergency plan for patient transfer to a tertiary cardiac hospital in the unlikely event that surgery was needed. Earlier smaller series of patients treated with primary PCI at centers without cardiac surgical backup have shown that this procedure can be done at such facilities and the outcomes are good and comparable to results in centers with onsite surgery.311

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