Percutaneous coronary interventions without on-site cardiac surgery: a remote Australian experience

Abstract

BACKGROUND: The current American College of Cardiology (ACC) guidelines recommend that elective percutaneous coronary interventions (PCI) should not be performed in institutions without on-site cardiac surgery. We sought to determine the safety of PCI without cardiac surgical support on-site and specifically the safety of complex elective procedures. The results of the first 1000 procedures performed at our institution, which is a rural centre 80 km from the nearest cardiac surgical facility, are reported. METHODS: Between September 2002 and April 2006 a total of 1000 procedures were performed in 893 patients at our institution. Patients included both high and low risk cohorts. Clinical and procedural outcomes were recorded and analysed. RESULTS: Of the 921 elective and 79 emergency primary PCI procedures performed, 1138 vessels were treated and 1429 stents deployed. A 95% procedural success rate was recorded. Complex PCI was performed with multi-vessel PCI in 13%, bifurcation PCI in 8%, chronic total occlusions (CTO) in 5%, saphenous vein graft interventions in 5%, unprotected left main interventions in 0.8% and rotational atherectomy in 0.8% of all procedures performed. Of the cohort, 75.3% of the lesions treated were either American College of Cardiology (ACC)/American Heart Association (AHA) type B or C lesions. In the primary PCI group, three deaths and three sub-acute stent occlusions occurred. In the elective group, the following major complications occurred: one death, three sub-acute stent occlusions, one case of contrast nephropathy requiring short-term dialysis, two cases of cardiac tamponade, two significant femoral pseudo-aneurysms and one misplaced stent. Acute myocardial infarction occurred in 21 patients. There were no urgent transfers for CABG surgery to salvage a complication of PCI. CONCLUSION: PCI including high risk elective procedures can safely be performed without on-site cardiac surgery by experienced high volume operators.