Elective percutaneous coronary intervention without on-site surgical backup: a community hospital experience.

abStraCtContext: The American College of Cardiology guide-lines consider elective percutaneous coronary interven-tion (PCI) without on-site surgical backup (OSB) a Class-III indication.Objective: Our objective was to determine the safety of elective PCI without OSB.Design: The study is a prospective analysis of a cohort of patients who underwent elective PCI without OSB at our institution. All patients were at our community satellite institution in Beloit, Wis. Three hundred twen-ty-one elective interventions were performed (mean age 64±12, 68% male). The prevalence of diabetes and hypertension was 28% and 82.5% respectively.Intervention: A predefined protocol was designed to transfer patients to a cardiac surgical facility if nec-essary. An experienced interventional cardiologist reviewed the diagnostic angiograms. Patients with com-plex lesions were excluded from the study.Main Outcome Measure: Any procedure-related death or emergency coronary artery bypass graft surgery.Results: Three hundred eighty-two vessels were stented. Multi-vessel intervention was performed in 61 patients (19%). Only 5% of lesions were type C. Four hundred thirty-seven stents were deployed. IIb-IIIa inhibitors were used in 77 (24%) cases. Procedural success was 99.7%. There were no deaths, myocardial infarctions nor need for urgent target vessel revascularization at 6 months.Conclusion: With careful patient/lesion selection, an ex-perienced interventional cardiologist and a predefined transfer protocol, elective PCI without OSB can be performed safely.intrOduCtiOnThe initial experience with percutaneous coronary in-tervention (PCI) indicated the need for on-site surgical backup for emergency coronary artery bypass graft sur-gery (ECABG) in up to 4% of the cases.