Abstract
OBJECTIVE--To determine whether percutaneous transluminal coronary angioplasty may be safely performed in cardiology centres in the United Kingdom without immediate on site cardiac surgical cover for complications arising at angioplasty. DESIGN--Retrospective review of coronary angioplasties and complications in a hospital without on site cardiac surgical cover. SETTING--All angioplasties were performed in the catheterisation laboratory of the Belfast City Hospital. Revascularisation surgery for complicated coronary angioplasty was performed in the cardiac surgical unit of the Royal Victoria Hospital, 2.4 km away from the catheterisation laboratory. PATIENTS--540 Coronary angioplasties were performed on 512 patients between late 1982 and November 1988. Indications included stable angina, unstable rest angina, and suitable coronary disease at coronary arteriography after myocardial infarction. MAIN OUTCOME MEASURES--In hospital mortality after complicated coronary angioplasty and delay to surgical revascularisation after acute coronary occlusion at angioplasty. RESULTS--Coronary angioplasty was successful in 444 cases (82%). Acute coronary occlusion occurred in 35 cases (6.5%). Twelve patients required urgent revascularisation surgery and were transferred safely to the surgical unit; none of these patients died. A mean delay of 268 minutes (range 180-390 minutes) occurred before revascularisation compared with 273 minutes (range 108-420 minutes) in the Royal Victoria Hospital, where on site surgical cover was available. The principal cause of delay was the wait for a cardiac operating theatre to become available and not the transfer time between hospitals. Five deaths occurred after coronary angioplasty, a mortality of 0.9%. Three deaths were related to acute coronary occlusion. The absence of immediate surgical help did not influence the outcome in any patient. CONCLUSION--With careful selection of patients coronary angioplasty may be safely performed in a hospital without on site cardiac surgical facilities, provided that these are available at a nearby centre.
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Selected References
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- Califf R. M., Tomabechi Y., Lee K. L., Phillips H., Pryor D. B., Harrell F. E., Jr, Harris P. J., Peter R. H., Behar V. S., Kong Y. Outcome in one-vessel coronary artery disease. Circulation. 1983 Feb;67(2):283–290. doi: 10.1161/01.cir.67.2.283. [DOI] [PubMed] [Google Scholar]
- Detre K., Holubkov R., Kelsey S., Cowley M., Kent K., Williams D., Myler R., Faxon D., Holmes D., Jr, Bourassa M. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981. The National Heart, Lung, and Blood Institute Registry. N Engl J Med. 1988 Feb 4;318(5):265–270. doi: 10.1056/NEJM198802043180501. [DOI] [PubMed] [Google Scholar]
- Myers W. O., Davis K., Foster E. D., Maynard C., Kaiser G. C. Surgical survival in the Coronary Artery Surgery Study (CASS) registry. Ann Thorac Surg. 1985 Sep;40(3):245–260. doi: 10.1016/s0003-4975(10)60037-9. [DOI] [PubMed] [Google Scholar]
- Reeves T. J., Oberman A., Jones W. B., Sheffield L. T. Natural history of angina pectoris. Am J Cardiol. 1974 Mar;33(3):423–430. doi: 10.1016/0002-9149(74)90327-0. [DOI] [PubMed] [Google Scholar]
- Ryan T. J., Faxon D. P., Gunnar R. M., Kennedy J. W., King S. B., 3rd, Loop F. D., Peterson K. L., Reeves T. J., Williams D. O., Winters W. L., Jr Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988 Aug;78(2):486–502. doi: 10.1161/01.cir.78.2.486. [DOI] [PubMed] [Google Scholar]