Abstract 1999: Percutaneous Coronary Intervention with Off-site Cardiac Surgery Backup for Acute Myocardial Infarction as a Strategy to Reduce Door-to-Balloon Time.
We sought to determine whether primary percutaneous coronary intervention (PCI) for patients admitted with an acute ST-segment elevation myocardial infarction (STEMI) can be performed more rapidly and with comparable outcomes in a community hospital vs. a tertiary center with cardiac surgery. We started the first PCI with off-site surgery program in the Netherlands in 2002 and report the results of 639 consecutive pts. In the safety phase, 199 patients presenting with STEMI were randomly assigned to treatment at our off-site center vs a more distant cardiac surgery center. In the confirmation phase, 440 consecutive patients were treated in the off-site hospital. Safety and efficacy endpoints were the rate of angiographically successful PCI procedure (diameter stenosis <50% and TIMI 3 flow) in the absence of major adverse cardiac and cerebrovascular events (MACCE) at 30 days. The randomization phase showed a significant decrease of 37 minutes in door-to-balloon time (p<0.001) with comparable procedural and clinical success (91% TIMI-3 flow in both groups). In the confirmation phase, the 30-day MACCE-free rate was 95%. None of the 639 patients in the study required emergency surgery for failed primary PCI. Time to treatment with primary PCI can be significantly reduced when treating patients in a community hospital setting with off-site cardiac surgery backup as compared with transport for PCI to a referral center with on-site surgery. PCI at hospitals with off-site cardiac surgery backup can be considered as one of the needed strategies to improve access to primary PCI for a larger segment of the population basis, and can be delivered with a very favorable safety profile.