Percutaneous transluminal coronary angioplasty (PTCA) without on-site surgical facilities

Background: Numerous publications from European and Canadian centres have documented the feasibility of performing percutaneous transluminal coronary angioplasty (PTCA) without on-site surgical facilities. The absolute need for surgical standby has been changing especially with the introduction of coronary stent for bailout situations. This practice maybe applicable in Australian centres especially in the environment of long waiting lists and cost containment. Aim: To review the safety of performing PTCA by experienced operators in two Melbourne hospitals without on-site surgical facilities. Methods: We reviewed data of all patients who had PTCA electively (with low and moderate risks) between July 1996 and January 1997 and in the setting of acute myocardial infarction (AMI) from January 1996 to January 1997. Surgical standby was available as 'next available room' basis in nearby centres. Immediate outcome before discharge was documented and follow up from three to six months in 80% of all surviving patients. Results: There were 46 elective PTCA and 41 PTCA for AMI. PTCA was successful in 82 (94%) patients. Among the elective cases, seven patients were already inpatients with unstable or postinfarct angina. Thirteen patients had stents deployed with three for acute closure. Abciximab (Reopro) was given to eight patients. Two patients had acute closure in the laboratory which could not be reopened, but did not require emergency coronary artery bypass grafting (CABG). There were four inhospital deaths (three related to AMI and one died of a noncoronary cause). Conclusion: PTCA can be performed electively in st selected group of patients with coronary artery disease and as a primary procedure for AMI without on-site surgical standby.