Nonemergent percutaneous coronary interventions in a veterans affairs medical center without onsite cardiac surgery

Percutaneous coronary intervention (PCI) performed in centers without onsite cardiac surgery remains controversial. Advances in PCI techniques and medical therapy have markedly decreased postprocedural complications. Our aim was to assess the efficacy and safety of performing PCI in the Veterans Affairs patient population in a hospital without onsite cardiac surgery.

We prospectively evaluated 401 consecutive patients who underwent elective PCI or PCI after admission for acute coronary syndrome. Patients who had ST-elevation myocardial infarction or were hemodynamically unstable were classified as emergent and had their PCI performed elsewhere and were therefore excluded from our analysis. Our cardiac surgery backup was a community hospital 8 miles away.

The patient's mean age was 65.6 +/- 10 years, and most were men (99.5%). Patients had high-risk clinical and angiographic profiles, with diabetes mellitus in 44%, prior myocardial infarction in 41%, comorbid conditions in 45% and type B or C angiographic lesions in 83%. Of 401 patients, 338 (84%) received a stent, and 86 (21%), a drug eluting stent. Percutaneous coronary intervention success rate was 97%. There were no periprocedural or inhospital deaths, and no patients required emergency transfer for cardiac surgery. At 1 and 6 months of follow-up, total mortality was 1.5% and 3.5%, respectively; target vessel revascularization rate was 0% and 1.7%.

Nonemergent PCI can be performed effectively and safely in patients with higher clinical and angiographic risk without onsite backup cardiac surgery. This has significant implications for most hospitals that have an invasive but not an interventional program.