PCI Safe in Hospitals Lacking Cardiac Surgery Units

Cheryl Clark, for HealthLeaders Media , March 28, 2012

Aversano acknowledged that it is a controversial topic. Many cardiologists firmly believe that hospitals without cardiac surgery backup should not perform PCI procedures because errors and adverse events do occur.

Historically, experience with the earliest PCI procedures in 1979 showed that "10% of the patients required emergency coronary artery bypass grafting," Aversano's paper said. Complications include coronary occlusion resulting in myocardial infarction, artery perforation, coronary dissection or so-called no reflow, or the patient having a heart attack mid procedure.

Guidelines from professional organizations such as the American College of Cardiology and the American Heart Association nixed elective angioplasty procedures at hospitals that could not promptly perform rescue surgery.

But by 2002, the rate had declined to .15, and since then, with increased operator and facility experience, those complications rates dropped even further.  In California and some other states, many hospitals perform PCI without surgical backup as long as they have rapid transfer agreements with hospitals that do.

But Aversano cautions against over-interpreting or misunderstanding the study's findings. "One of the downsides is taking this research and saying, 'OK, now, anybody can do angioplasty. So let's just buy the catheters and let's have at it.' That's absolutely false."

Rather, the hospitals and interventionalists who participated in this research project met strict criteria. "They underwent a very formal, very detailed angioplasty development program that we supervised and that we monitored, part of which involved the application of guidelines, the development of logistics and care plans and pathways. And there are political issues that have to be addressed in each community hospital (first) to importantly affect patient care."

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