Abstract 15234: Thirty Years' Experience from the First Canadian Standalone Percutaneous Coronary Intervention Centre - Results and Insights from 23,914 Cases

Background: With the increasing demand for catheter based revascularization for coronary artery disease, the practice of percutaneous coronary intervention (PCI) in centres without cardiac surgical backup continues to gain worldwide acceptance. In 1981 the Royal Alexandra Hospital was the first Canadian centre to perform standalone PCI. Surgical backup was provided at the University Of Alberta Hospital located 6 km away. Since inception the program has performed elective, urgent in-patient and emergency PCIs, supported by a full range of interventional technologies including intra-aortic balloon pump, stents (since 1993), IVUS, FFR, cutting balloons, rotational atherectomy and Impella circulatory support. A chronic total occlusion PCI program was established in 2010. We report our experience of 23,914 PCI procedures from July 1981 to April 2012, and compare our outcomes with benchmarks in current literature. Methods: A comparative analysis was carried out on clinical presentation, procedure numbers, characteristics, and outcomes collected over 4 separate time periods: 1981-91, 1992-2001, 2002-06 and 2007-April 2012. Results: Since 1981 the number of PCI procedures has increased significantly, concurrent with an increased number of ad hoc procedures, patients with Class 4 angina, ST elevation myocardial infarction (STEMI) and use of coronary stents. Procedure success rates have also improved as death rate and the need for emergency cardiac surgery for PCI complications decreased (Table). Our outcomes compare favourably against benchmarks quoted by the National Cardiovascular Data Registry (mortality 0.6-4.81%, emergency cardiac surgery 0.4%). Conclusion: PCI can be safely performed in an experienced high volume standalone centre with high success and very low complication rates. These results support the safety of establishing new standalone PCI centres to meet the growing demand for percutaneous revascularization for coronary disease.