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Jan 10, 2012

Safety of PCI at Centers Without On-Site Surgery

Study shows that PCI is just as safe at hospitals with and without on-site surgery.

Current medical guidelines advise against centers without on-site surgery performing elective percutaneous coronary intervention—a minimally invasive procedure that helps widen coronary arteries to increase blood flow to the heart, reducing risk for heart attack and stroke. Why? Although percutaneous coronary intervention (PCI) is non-surgical, there can be complications. In rare cases, up to five percent of patients undergoing PCI require emergency surgery if the procedure fails. And if a patient requiring emergency surgery is not at a center with on-site surgery or at one that performs fewer of these procedures, outcomes may be worse than at larger centers offering on-site surgery.

However, an analysis of 40 research studies recently showed that PCI outcomes may be no different between centers with and without on-site surgery. In this study, researchers analyzed data from over one million PCIs performed during a 20-year period between 1990 and 2010 both at hospitals with and without on-site surgery. They found that hospitals without on-site surgery had very similar outcomes compared to hospitals with on-site surgery and did not have higher in-hospital mortality rates.

Based on these findings, it is possible that with additional research, PCI recommendations may eventually be changed. If PCI is equally as safe at hospitals without on-site surgery, elective PCIs could be performed at all types of hospitals and medical centers. However, due to conflicting findings over the years, experts are likely to err on the side of caution until further studies prove that not only is there is in fact no difference in outcomes between hospitals with and without on-site surgery.

Questions for You to Consider

  • What is the difference between elective and emergency percutaneous coronary intervention (PCI)?

  • Emergency PCI is performed on patients suffering a serious type of heart attack known as a STEMI, in which there is complete blockage of a coronary artery, preventing blood flow and killing heart muscle. In this case, emergency PCI is used to restore blood flow to avoid long-term damage or death. Elective PCI, on the other hand, is when the procedure is planned ahead of time due to significant blockage of the arteries, in an effort to prevent future heart attack or stroke.

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