Clinical Evaluation of Percutaneous Coronary Interventions at a Secondary Hospital without Cardiac Surgical Capability

Myung, Hyung Jun; Lee, Seung Uk; Song, Yu Keun; Son, Du Sik; Lee, Hyun Jeong; Ko, Young Chun; Cho, Sang Ki

Abstract

Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for percutaneous coronary intervention (PCI) recommend minimum operator volume of 75 interventions per year (class I) and optimal institutional volume of 400 interventions per year (class I) or a minimum of 200 interventions per year (class IIa), as well as on-site cardiac surgery. But, recent advances in coronary stents and antiplatelet drugs have dramatically decreased procedural complications requiring emergency cardiac surgery. So, we studied the safety and efficacy of performing PCI at a low-volume secondary community hospital without cardiac surgical capability. Five hundred and fifty five cases of coronary angiography (CAG) and 138 cases of PCI were performed at our hospital from March, 2002 to December, 2003. We retrospectively evaluated clinical outcomes of PCI from 138 cases. Eighty one (58.7%) cases of stable angina, 49 (35.5%) cases of unstable angina, and 8 (5.8) cases of acute myocardial infarction were included. One hundred and sixty six lesions were treated with 144 (86.7%) coronary stents. Procedural success was achieved in 130 (94.2%) patients with 1 (0.7%) in-hospital death due to acute myocardial infarction. Two (1.4%) patients required emergent transfer due to procedural complications. At median follow-up of 9.4 3.1 months, no additional patients died of cardiac death or had recurrent myocardial infarction. One patient died of non-cardiac cause. Follow-up CAG was done in 72 (52.5%) cases. Eleven (8.0%) patients required target vessel revascularization. We conclude that PCI can be performed with safety and efficacy at a low-volume secondary hospital without cardiac surgical capability.