The Rouge Valley–Centenary, Stand-Alone PCI Pilot Study (RVC PPS) was a prospective assessment of the safety and efficacy of stand-alone PCI in a community hospital. Rouge Valley had an existing diagnostic cath lab, performing 2200 cases/y prior to the start of this study. A mentorship agreement and urgent transfer protocol was established with a cardiac surgical centre 30 km away. A 60 minute patient transfer protocol was demonstrated (from decision to arrival) and an electronic image transmission system was developed. Criteria for stand-alone PCI centres, established by the Cardiac Care Network of Ontario (CCN) expert panel and the Ministry of Health, were implemented throughout the study. In the first 250 patients, (phase 1) lesions were single vessel type A or B lesions, with LVEF> 30%. These criteria were modified halfway through the study (phase 2) to include type C lesions, multi-vessel disease, ostial lesions and LVEF <30%.

RESULTS: 500 consecutive patients were treated during the study. In Phase 1, 63% of patients referred for PCI were treated at RVC. In phase 2, 92% were treated at RVC. Primary lesion success of >99% was demonstrated for both phases. No patients were transferred for urgent bypass surgery. 23% of procedures were ad hoc (same day) and 38% trans-radial (in the second half of study). Currently, target vessel failure (TVF) is 4.1% reflecting the pre drug-eluting-stent (DES) period. Restenosis in bare metal stents was treated at RVC with DES in 62% of cases. DES was used in 41% of all patients, after funding was obtained.

CONCLUSIONS: We have demonstrated that that with current technology, PCI can be performed in non-surgical community centres with a high degree of safety and efficacy in most patients eligible for PCI. A correlation between lesion complexity and adverse outcome was not observed. A significant decrease in waiting time for the procedure was demonstrated. Patient satisfaction, Seattle Angina Score (pre and post) and cost analysis data will be presented.

DNC

NEXT