Percutaneous coronary intervention role of onsite surgical backup

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 and 2005 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1][2]

Role of Onsite Cardiac Surgical Back-Up (DO NOT EDIT)[2]

Class I
"1. Elective PCI should be performed by operators with acceptable annual volume (at least 75 procedures per year) at high-volume centers (more than 400 procedures annually) that provide immediately available onsite emergency cardiac surgical services. (Level of Evidence: B)"
"2. Primary PCI for patients with STEMI should be performed in facilities with onsite cardiac surgery.(Level of Evidence: B)"
Class III
"1. Elective PCI should not be performed at institutions that do not provide onsite cardiac surgery. (Level of Evidence: C)"

PCI in Hospitals Without On-Site Surgical Backup (DO NOT EDIT)[1]

Class III (Harm)

"1. Primary or elective PCI should not be performed in hospitals without on-site cardiac surgery capabilities without a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital or without appropriate hemodynamic support capability for transfer. (Level of Evidence: C)"

Class IIa

"1. Primary PCI is reasonable in hospitals without on-site cardiac surgery, provided that appropriate planning for program development has been accomplished.[3][4] (Level of Evidence: B)"

Class IIb

"1. Elective PCI might be considered in hospitals without on-site cardiac surgery, provided that appropriate planning for program development has been accomplished and rigorous clinical and angiographic criteria are used for proper patient selection.[4][5][6] (Level of Evidence: B)"

References

  1. 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB; et al. (2006). "ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention)". Circulation. 113 (7): e166–286. doi:10.1161/CIRCULATIONAHA.106.173220. PMID 16490830.
  3. Aversano T, Aversano LT, Passamani E, Knatterud GL, Terrin ML, Williams DO, Forman SA (2002). "Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial". JAMA : the Journal of the American Medical Association. 287 (15): 1943–51. PMID 11960536. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Dehmer GJ, Blankenship J, Wharton TP, Seth A, Morrison DA, Dimario C, Muller D, Kellett M, Uretsky BF (2007). "The current status and future direction of percutaneous coronary intervention without on-site surgical backup: an expert consensus document from the Society for Cardiovascular Angiography and Interventions". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 69 (4): 471–8. doi:10.1002/ccd.21097. PMID 17278155. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  5. Melberg T, Nilsen DW, Larsen AI, Barvik S, Bonarjee V, Kuiper KK, Nordrehaug JE (2006). "Nonemergent coronary angioplasty without on-site surgical backup: a randomized study evaluating outcomes in low-risk patients". American Heart Journal. 152 (5): 888–95. doi:10.1016/j.ahj.2006.06.026. PMID 17070152. Retrieved 2011-12-06. Unknown parameter |month= ignored (help)
  6. Singh PP, Singh M, Bedi US, Adigopula S, Singh S, Kodumuri V, Molnar J, Ahmed A, Arora R, Khosla S (2011). "Outcomes of nonemergent percutaneous coronary intervention with and without on-site surgical backup: a meta-analysis". American Journal of Therapeutics. 18 (2): e22–8. doi:10.1097/MJT.0b013e3181bc0f5a. PMID 19918168. Retrieved 2011-12-06.

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