On-site surgical facilities not essential for performing PCI

May 2008
P7


A new study suggests that percutane -
ous coronary intervention (PCI) can be safely performed at facilities where patients
must be transferred off-site in order
to undergo surgery in the event of complications
– a finding likely to change practice
guidelines.
PCI can lead to complications such as
cardiac muscle rupture and myocardial
perforation, and current guidelines recommend
these procedures only be undertaken
at centers where cardiac surgery can be
performed on-site.
“Off-site PCI centers can provide excellent
care to patients if the organization of
the program is thoughtfully developed,”
said Dr. Michael Kutcher of Wake Forest
University in Winston-Salem, North Carolina,
US.
Kutcher presented figures from the
National Cardiovascular Data Registry
(NCDR), comparing the outcomes of
299,132 consecutive PCI procedures performed
at 404 on-site centers against those
of 9,029 procedures performed at 61 offsite
centers.
“The risk-adjusted mortality rate at
off-site facilities was comparable to those
PCI centers that have cardiac surgery onsite,”
he said, stressing however, that these
findings should not be used to encourage
the widespread introduction of off-site
PCI facilities.
Procedural success rates, morbidity and
rates of emergency coronary artery bypass
grafting (CABG) were also comparable for
the two types of center.
As well as assessing procedural outcomes,
the NCDR data were used to gain
insights into the organization and logistics
of off-site PCI centers. The researchers
found that these centers typically had fewer
beds and a lower annual volume of procedures
compared to on-site centers, but had
dedicated staff and facilities and provided
24 hour coverage. Off-site centers were also
capable of providing timely transfer to surgical
facilities, in the event that surgical intervention
was necessary. All off-site centers
performed both primary and elective PCI,
and tended to treat a higher proportion of
patients who presented with ST-segment
elevation and non-ST-segment elevation
myocardial infarction than on-site centers.
Commenting on the study findings, Dr.
Stephan Windecker of the Swiss Cardiovascular
Center in Bern, Switzerland, referred
to results from the Swedish Coronary
Angiography and Angioplasty Registry,
which also demonstrated comparable outcomes
for on-site and off-site PCI facilities.
He explained that technological advances
have enabled many complications of PCI to
be treated by non-surgical means, and that
emergency CABG after PCI is becoming increasingly
rare.
“I think the present study should give
the impetus to update the present guidelines,”
concluded Windecker. The researchers
“should be congratulated for putting
an end to a controversy which is as long as
angioplasty itself.