TABLE 1.

Structural indicators for percutaneous coronary intervention (PCI)

Structural indicator	Considerations
Minimum operator volume of at least 75 PCI procedures per year Minimum hospital volume of at least 400 PCI procedures per year	The minimum operator and hospital procedure volumes are determined by available data that showed consistent volume to outcome relationships. The panel is cognizant that some Canadian centres may not meet these targets due to unique situations. In these cases, the panel recommended an ongoing relationship between low-volume centres and high-volume centres
PCI centres performing primary PCI should track their door-to-balloon time and important time intervals for ongoing quality improvement feedback	Important components of the door-to-balloon time can include the door-to-electrocardiogram time, diagnosis-to-catheterization laboratory time and catheterization laboratory-to-balloon time. A hospital tracking system should be in place to record time intervals for continuous quality improvement in door-to-balloon time. A mechanism should be in place to report these times to hospital stakeholders within one week to ensure timely feedback and to identify areas for quality improvement
A standardized protocol should be in place to minimize contrast-induced nephropathy for PCI patients	Because no universally accepted prophylactic treatment against contrast-induced nephropathy is available, each hospital should have a standardized protocol to identify and initiate prophylaxis for patients at risk
A standardized protocol should be in place to ensure appropriate periprocedural antithrombin therapy during PCI	Many antithrombin therapies have been demonstrated to be effective as adjunctive therapy during PCI. However, it has also been shown that the use of these medications are prone to dosing error. Each hospital should have a standardized protocol to minimize the chance of medication errors
Standardized discharge plans should be established for PCI patients	Discharge planning should be comprehensive and include a discussion on the importance of compliance with dual antiplatelet therapy after stent placement, smoking cessation, diet modification and exercise to improve the overall outcome of PCI patients