Editorial Comment

In this historical period for our profession, we are regularly faced with complex and perplexing challenges. Non-primary percutaneous coronary intervention (PCI) with no on-site cardiac surgery continues to be a subject of active debate. Several previous studies have demonstrated that there are no apparent advantages to on-site cardiac surgery for patients who are undergoing either primary or non-primary PCI. In this small series of 70 patients with left main coronary artery disease, Cheng et al. (Acta Cardiol Sin 2015;31:267-279) reported no procedure-related mortality and no need to convert to emergency coronary artery bypass grafting (CABG). I believe that the authors of this study deserve recognition for their excellent work and scholarly contribution. However, the long-term outcomes were disappointing. The mortality rate was 30% at 1 year and 42.9% at 3 years. Interestingly, mortality was much higher than the results reported from the majority of other Taiwan hospitals that perform on-site cardiac surgery. According to the reported risk profiles, their patients had high rates of associated multi-vessel disease (78.6%), diabetes mellitus (42.9%), uremia (15.7%), and a SYNTEX score over 33 (55.7%). For these high-risk patients, PCI or CABG is not unequivocally beneficial. We need to inform our patients about the variety of options that will ultimately be available. In Taitung county, CABG can be performed electively for high-risk patients with a collaborative team including cardiac surgeons, cardio-logists, intensivists and hospitalists in order to achieve a better long-term outcome.