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Percutaneous coronary intervention without onsite surgical backup

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Abstract

Although accepted in several countries abroad, the performance of percutaneous coronary intervention (PCI) without onsite surgical backup is controversial in the United States. Current guidelines from the United States do not endorse elective PCI in facilities without onsite surgical backup but acknowledge that primary PCI for ST-segment elevation myocardial infarction is acceptable under carefully regulated and monitored circumstances. This differs from guidelines developed by organizations in other countries. In the United States, data indicate that primary alone or primary and elective PCI without onsite surgery is currently being performed in all but seven states, and the number of patients treated in this setting is increasing. More than 40 articles reporting the outcomes and safety of PCI without onsite surgical backup have been published, but these are from a limited number of centers and are retrospective reviews or prospective registries, which have inherent limitations. Additional studies are currently under way to evaluate PCI’s safety and effectiveness in this setting.

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References and Recommended Reading

  1. Detre KM, Holubkov R, Kelsey S, et al.: Percutaneous transluminal coronary angioplasty in 1985–1986 and 1977–1981. The National Heart, Lung, and Blood Institute Registry. N Engl J Med 1988, 318:265–270.

    PubMed  CAS  Google Scholar 

  2. Williams DO, Holubkov R, Yeh W, et al.: Percutaneous coronary intervention in the current era compared with 1985–1986. The National Heart, Lung, and Blood Institute Registries. Circulation 2000, 102:2945–2951.

    PubMed  CAS  Google Scholar 

  3. Yang EH, Gumina RJ, Lennon RJ, et al.: Emergency coronary artery bypass surgery for percutaneous coronary interventions. J Am Coll Cardiol 2005, 46:2004–2009.

    Article  PubMed  Google Scholar 

  4. Seshadri N, Whitlow PL, Acharya N, et al.: Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation 2002, 106:2346–2350.

    Article  PubMed  Google Scholar 

  5. Reinecke H, Fetsch T, Roeder N, et al.: Emergency coronary artery bypass grafting after failed coronary angioplasty: what has changed in a decade? Ann Thorac Surg 2000, 70:1997–2003.

    Article  PubMed  CAS  Google Scholar 

  6. Keeley EC, Boura JA, Grines CL: Primary angioplasty vs. intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003, 361:13–20.

    Article  PubMed  Google Scholar 

  7. Boersma E; The Primary Coronary Angioplasty vs. Thrombolysis Group: Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 2006, 27:779–788.

    Article  PubMed  Google Scholar 

  8. Cannon CP, Gibson CM, Lambrew CT, et al.: Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 2000, 283:2941–2947.

    Article  PubMed  CAS  Google Scholar 

  9. De Luca G, Suryapranata H, Ottervanger JP, Antman EM: Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004, 109:1223–1225.

    Article  PubMed  Google Scholar 

  10. Hutter AM Jr, Weaver WD: 31st Bethesda Conference. Emergency cardiac care. Task Force 2: Acute coronary syndromes: Section 2A—prehospital issues. J Am Coll Cardiol 2000, 35:846–853.

    PubMed  Google Scholar 

  11. Keeley EC, Boura JA, Grines CL: Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet 2006, 367:543–546.

    Article  Google Scholar 

  12. Nallamothu BK, Bates ER, Herrin J, et al.: Time to treatment in transfer patient undergoing primary percutaneous coronary intervention in the United States. National Registry of Myocardial Infarction (NRMI-3/4) analysis. Circulation 2005, 111:761–767.

    Article  PubMed  Google Scholar 

  13. Krumholtz HM, Bradley EH, Nallamothu BK, et al.: A campaign to improve the timeliness of primary percutaneous coronary intervention. J Am Coll Cardiol Intv 2008, 1:97–104.

    Google Scholar 

  14. Henry TD, Atkins JM, Cunningham MS, et al.: ST-segment elevation myocardial infarction: recommendations on triage of patients to heart attack centers. Is it time for a national policy for the treatment of ST-segment elevation myocardial infarction? J Am Coll Cardiol 2006, 47:1339–1345.

    Article  PubMed  Google Scholar 

  15. Jacobs AK, Antman EM, Ellrodt G, et al.: Recommendation to develop strategies to increase the number of ST-segment-elevation myocardial infarction patients with timely access to primary percutaneous coronary intervention. The American Heart Association’s Acute Myocardial Infarction (AMI) Advisory Working Group. Circulation 2006, 113:2152–2163.

    Article  PubMed  Google Scholar 

  16. Wharton TP, McNamara NS, Fedele FA, et al.: Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery. J Am Coll Cardiol 1999, 33:1257–1265.

    Article  PubMed  Google Scholar 

  17. Aversano T, Aversano LT, Passamani E, et al.: Thrombolytic therapy vs. primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial. JAMA 2002, 287:1943–1951.

    Article  PubMed  Google Scholar 

  18. Wharton TP Jr: Should patients with acute myocardial infarction be transferred to a tertiary center for primary angioplasty or receive it at qualified hospitals in the community? The case for community hospital angioplasty. Circulation 2005, 112:3509–3534.

    Article  PubMed  Google Scholar 

  19. Dehmer GJ, Blankenship J, Wharton TP, et al.: The current status and future direction of percutaneous coronary intervention without on-site surgical backup: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2007, 69:471–478. Full-length version available at http://www.mrw.interscience.wiley.com/suppmat/1522-1946/suppmat/index.html. Accessed May 29, 2008.

    Article  PubMed  Google Scholar 

  20. Dehmer GJ, Kutcher MA, Dey S, et al.: Performing percutaneous coronary intervention at facilities without onsite cardiac surgical backup is increasing: a report from the American College of Cardiology — National Cardiovascular Data Registry (ACC-NCDR). Am J Cardiol 2007, 99:329–332.

    Article  PubMed  Google Scholar 

  21. British Cardiovascular Interventional Society: BCIS Audit Returns 2006. Available at http://www.bcis.org.uk/resources/audit/audit_2006. Accessed April 14, 2008.

  22. Carlsson J, James SN, Ståhle E, et al.: Outcome of percutaneous coronary intervention in hospitals with and without on-site cardiac surgery standby. Heart 2007, 93:335–338.

    Article  PubMed  Google Scholar 

  23. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, et al.: ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006, 47:e1–e121.

    Article  PubMed  Google Scholar 

  24. Silber S, Albertsson P, Aviles FF, et al.: Guidelines for percutaneous coronary interventions: the task force for percutaneous coronary interventions of the European Society of Cardiology. Eur Heart J 2005, 26:804–847.

    Article  PubMed  Google Scholar 

  25. Dawkins KD, Gershlick T, de Belder M, et al.: Coronary angioplasty: guidelines for good practice and training. Heart 2005, 91(Suppl 6):vi1–vi27.

    Article  PubMed  Google Scholar 

  26. Cumpston N; the Interventional Working Group: Policy on support facilities for coronary angiography and percutaneous coronary intervention. The Council of the Cardiac Society of Australia and New Zealand, August 8, 2003. Available at http://www.csanz.edu.au/guidelines/practice/POLICY_ON_SUPPORT_FACILITES_FOR_CORONARY_ANGIOGRAPHY.pdf. Accessed April 14, 2008.

  27. Brieger D; the Interventional Working Group: Policy on performance of coronary angiography and percutaneous coronary intervention in rural sites. The Council of the Cardiac Society of Australia and New Zealand, November 25, 2005. Available at http://www.csanz.edu.au/guidelines/practice/Performance_of_coronary_angiography_and_PCI_in_rural_sites.pdf. Accessed April 14, 2008.

  28. Oliveras EE, Hernández Antolín RA, et al.: Requirements to perform coronary interventions at hospitals without coronary surgery. Guidelines of the Spanish Society of Cardiology. Rev Esp Cardiol 1999, 52:5–12.

    Google Scholar 

  29. Aengevaeren WRM, Ten Berg JM, van Boven AJ, et al.: Dutch guidelines for interventional cardiology. Institutional and operator competence and requirements for training. Available at http://www.nvvc.nl/UserFiles/File/Pdf/20041012_interventionalcardiology_v081004.pdf. Accessed April 14, 2008.

  30. Guimaraes JI, Sousa JE, Ribeiro E, et al.: Guidelines for the indications and use of percutaneous interventions and intracoronary stent in clinical practice. Arq Bras Cardiol 2003, 80(Suppl 1):1–14.

    PubMed  Google Scholar 

  31. Legrand V, Wijns W, Vandenbranden F, et al.: Guidelines for percutaneous coronary intervention by the Belgian Working Group on Invasive Cardiology. Acta Cardiol 2003, 58:341–348.

    Article  PubMed  Google Scholar 

  32. Ting HH, Raveendran G, Lennon RJ, et al.: A total of 1,007 percutaneous coronary interventions without onsite cardiac surgery. Acute and long-term outcomes. J Am Coll Cardiol 2006, 47:1713–1721.

    Article  PubMed  Google Scholar 

  33. Paraschos A, Callwood D, Wightman MB, et al.: Outcomes following elective percutaneous coronary intervention without on-site surgical backup in a community hospital. Am J Cardiol 2005, 95:1091–1093.

    Article  PubMed  Google Scholar 

  34. Brown DC, Mogelson S, Harris R, et al.: Percutaneous coronary interventions in a rural hospital without surgical backup: report of one year of experience. Clin Cardiol 2006, 29:337–340.

    Article  PubMed  Google Scholar 

  35. Frutkin AD, Mehta SK, Patel T, et al.: Outcomes of 1,090, consecutive, elective, nonselected percutaneous coronary interventions at a community hospital without onsite cardiac surgery. Am J Cardiol 2008, 101:53–57.

    Article  PubMed  Google Scholar 

  36. Wennberg DE, Lucas FL, Siewers AE, et al.: Outcomes of percutaneous coronary interventions performed at centers without and with onsite coronary artery bypass graft surgery. JAMA 2004, 292:1961–1968.

    Article  PubMed  CAS  Google Scholar 

  37. O’Connor GT, Malenka DJ, Quinton H, et al.: Multivariate prediction of in-hospital mortality after percutaneous coronary interventions in 1994–1996. Northern New England Cardiovascular Disease Study Group. J Am Coll Cardiol 1999, 34:681–691.

    Article  PubMed  CAS  Google Scholar 

  38. Kutcher MA, Klein LW, Wharton TP Jr, et al.: Percutaneous coronary interventions in facilities without on-site cardiac surgery: a report from the National Cardiovascular Data Registry (NCDR). Presented at the Society for Cardiovascular Angiography and Interventions — American College of Cardiology-i2 Meeting. Chicago, IL; March 29–April 1, 2008. (Late Breaking Clinical Trials abstract 2401–2413.)

  39. Magid DJ, Wang Y, Herrin J, et al.: Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA 2005, 294:803–812.

    Article  PubMed  CAS  Google Scholar 

  40. Peels HO, de Swart H, Ploeg TVD, et al.: Percutaneous coronary intervention with off-site cardiac surgery backup for acute myocardial infarction as a strategy to reduce door-to-balloon time. Am J Cardiol 2007, 100:1353–1358.

    Article  PubMed  Google Scholar 

  41. Jacobs AK: Primary percutaneous coronary intervention without cardiac surgery on-site: coming to a hospital near you? Am Heart J 2008, 155:585–588.

    Article  PubMed  Google Scholar 

  42. Eagle KA, Nallamothu BK, Mehta RH, et al.: Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 2008, 29:609–617.

    Article  PubMed  Google Scholar 

  43. Nallamothu BK, Bates ER, Wang Y, et al.: Driving times and distances to hospitals with percutaneous coronary intervention in the United States: implications for prehospital triage of patients with ST-elevation myocardial infarction. Circulation 2006, 113:1189–1195.

    Article  PubMed  Google Scholar 

  44. Buckley JW, Bates ER, Nallamothu BK: Primary percutaneous coronary intervention expansion to hospitals without on-site cardiac surgery in Michigan: a geographic information systems analysis. Am Heart J 2008, 155:668–672.

    Article  PubMed  Google Scholar 

  45. Henry TD, Sharkey SW, Burke MN, et al.: A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation 2007, 116:721–728.

    Article  PubMed  Google Scholar 

  46. Aguirre FV, Varghese JJ, Kelley MP, et al.: Rural interhospital transfer of ST-elevation myocardial infarction patients for percutaneous coronary revascularization. The Stat Heart Program. Circulation 2008, 117:1145–1152.

    Article  PubMed  Google Scholar 

  47. Blakenship JC, Haldis TA, Wood GC, et al.: Rapid triage and transport of patients with ST-elevation myocardial infarction for percutaneous coronary intervention in a rural health system. Am J Cardiol 2007, 100:944–948.

    Article  Google Scholar 

  48. Jollis JG, Roettig ML, Aluko AO, et al.: Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction. JAMA 2007, 298:2371–2380.

    Article  PubMed  CAS  Google Scholar 

  49. Moyer P, Feldman J, Levine J, et al.: Implications of the mechanical (PCI) vs thrombolytic controversy for ST segment elevation myocardial infarction on the organization of emergency medical services: the Boston EMS experience. Crit Pathw Cardiol 2004, 3:53–61.

    PubMed  Google Scholar 

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  1. Cardiology Division, Scott and White Clinic, Texas A&M University College of Medicine, 2401 South 31st Street, Temple, TX, 76508, USA

    Gregory J. Dehmer

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Correspondence to Gregory J. Dehmer.

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Dehmer, G.J. Percutaneous coronary intervention without onsite surgical backup. Curr Cardiol Rep 10, 407–414 (2008). https://doi.org/10.1007/s11886-008-0064-7

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