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Current Research: Cardiology

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Thirty years of standalone percutaneous coronary interventions: A 23,261 case experience from a Canadian tertiary referral centre

Author(s): William KK Hui*, David G O´Brien, Neil S Brass, Po Kee Cheung, Michael CY Chan, Raymond CM Leung, Benjamin D Tyrrell, Shantu Bundhoo, Pitak Pongnonthachai, P Diane Galbraith, Keysun Ranjbar, Micha Dorsch, Roderick MacArthur and W Peter Klinke

Background: When percutaneous coronary intervention (PCI) was first performed >35 years ago, on-site cardiac surgery backup for PCI failure was deemed essential. As techniques improved and primary PCI became the preferred reperfusion strategy for acute myocardial infarction, many standalone PCI programs originally established to facilitate access to primary PCI started to perform elective PCI, which remains a Class IIb recommendation in American College of Cardiology Foundation/American Heart Association/Society for Cardiac Angiography and Interventions guidelines. Two recent United States studies showed that outcomes of elective PCI in standalone centres were noninferior to those with on-site cardiac surgery. The Royal Alexandra Hospital in Edmonton (Alberta) performed the first standalone PCI in Canada in 1981.

Objectives: The authors describe their first 30 years’ experience with PCI – the largest single-centre standalone experience reported to date.

Methods: Patient and procedural data have been collected since the first standalone PCI in 1981, evolving from paper records to a computer database and, in 1995, a provincial database. Quality assurance and peer review in collaboration with the regional cardiac surgery program was established from the outset.

Results: The success, emergency coronary bypass and death rates for 23,261 standalone PCIs performed between 1981 and 2011 were 96.0%, 0.2% and 0.5%, respectively. For 9068 PCIs performed between 2007 and 2011 (a period that most reflects contemporary practice), the rates were 96.5%, 0.04% and 0.6%, respectively. These results compare favourably with PCI results reported in literature, irrespective of the presence or absence of on-site cardiac surgery.

Conclusions: With high volumes and an experienced team, standalone PCIs can be performed safely with excellent success and low complication rates.

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Citations : 131

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Current Research: Cardiology