Recently, the 2007 SCAI/ACCF/AHA Expert Consensus Document on Percutaneous Coronary Intervention without On-Site Surgical Backup has been updated. The consensus document has found no indication of increased mortality or a greater need for emergency bypass surgery (CABG) for heart attack or elective PCI patients at centres without on-site cardiac surgery.

According to the consensus’ view, the procedures can be performed safely without on-site surgery; however, those facilities without backup cardiac surgery should have strict protocols for PCI to ensure the highest level of patient safety. Also the low-volume PCI programs, defined as performing PCI <200 per year, must ensure close monitoring of clinical outcomes and encourage collaboration with higher-volume centres. Also, “desires for personal or institutional financial gain, prestige, market share, or other similar motives are not appropriate considerations for initiation of PCI programs without on-site cardiac surgery”.

Dehmer GJ, Blankenship JC, Cilingiroglu M, et al. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv. 2014 Aug 1;84(2):169-87. doi: 10.1002/ccd.25371.