The number of percutaneous coronary intervention (PCI) procedures performed
each year has increased substantially, particularly since the introduction
of coronary stents. The current increase is being fueled by the shift from
thrombolysis to the performance of primary PCI for treatment of acute myocardial
infarction (MI). Also, with the availability of drug-eluting stents, patients
who previously would not have been eligible for PCI are now candidates for
this intervention. The drive to treat patients with acute ST-elevation MI
(STEMI) in a timely manner poses the question of whether many more moderate-sized
and often suburban hospitals, which in most cases do not have cardiac surgery
onsite, should provide primary PCI for patients with STEMI. On the surface,
it seems unnecessary to provide surgical backup onsite in such programs because
the need for emergency surgery for failed PCI for STEMI is small (1% or less).1,2 It would seem adequate to have an emergency
plan for patient transfer to a tertiary cardiac hospital in the unlikely event
that surgery was needed. Earlier smaller series of patients treated with primary
PCI at centers without cardiac surgical backup have shown that this procedure
can be done at such facilities and the outcomes are good and comparable to
results in centers with onsite surgery.3- 11
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