Clinical Study On Percutaneous Coronary Intervention Without Cardiac Surgery Backup

Purpose:evaluate the safety and feasibility of elective percutaneous coronary intervention(PCI) performed without cardiac surgery backup.Methods:from January 2008 to December 2009,we retrospectively collected the clinical data of 390 patients underwent elective PCI provided consecutively by Honghe Prefecture No.1 People's Hospital,Kaiyuan City People's Hospital,Qujing City No.1 People's Hospital,Chuxiong Prefecture People's Hospital and Dehong Prefecture People's Hospital and regarded it as the group without cardiac surgery backup.For the sake of contrast,we also retrospectively collected the clinical data of 433 patients underwent PCI provided consecutively by the coronary intervention team of Cardiac Internal Medicine Department of No.1 Affiliated Hospital of Kunming Medical University from January 2009 to December 2009 and regarded it as the group with cardiac surgery backup.Data collection includes the basic clinical data(age, gender,weight,LVEF,risk factors of coronary heart disease,complications and clinical diagnosis) of the patients,target vessel/lesion features,intervention, in-hospital period and clinical outcome at a 30-day follow-up.We compared the PCI procedural success rate,incidence rate of complications and incidence rate of 30d MACE of the two groups.Outcomes:1.Basic clinical data comparison:as a whole,the risk of basic clinical features of the group without cardiac surgery backup was lower than that with cardiac surgery backup.The average age of the group without cardiac surgery backup was lower than that with cardiac surgery backup(60.74±10.86V63.33±10.70,P=0.000).The proportion of the group without cardiac surgery backup elder than 75 was less than that with cardiac surgery backup(10.3%V15.2%,P=0.033);the proportion of the group without cardiac surgery backup with Type 2 diabetes was less than that with cardiac surgery backup(28.2%V35.6%,P=0.024);the proportion of the group without cardiac surgery backup suffering from old myocardial infarction(OMI) was less than that with cardiac surgery backup(12.6%V20.3%,P=0.003);the proportion of the group without cardiac surgery backup underwent percutaneous coronary intervention (PCI) previously was less than that with cardiac surgery backup(3.1%V10.6%, P=0.000) and the proportion of the group without cardiac surgery backup suffering from ST segment elevation myocardial infarction(STEMI) was more than that with cardiac surgery backup(23.3%V17.1%,P=0.026).All the rest indicators showed no significant differences(P＞0.05).2.Target vessel/lesion features comparison:the proportion of the group without cardiac surgery backup suffering from left main disease was less than that with cardiac surgery backup(0.8%V2.6%,P=0.021);the target lesion stegnosis degree of the group without cardiac surgery backup was minor than that with cardiac surgery backup(0.85±0.13V0.87±0.12,P=0.029);the proportion of the group without cardiac surgery backup suffering from Type C lesion change was less than that with cardiac surgery backup(19.9%V26.1%,P=0.036) and the proportion of the group without cardiac surgery backup suffering from CTO lesion change was less than that with cardiac surgery backup(5.7%V8.7%,P=0.048).The two groups showed no significant differences in target vessel distribution,lesion classification and bifurcation lesion(P＞0.05).As a whole,the risks of target vessel/lesion features of the group without cardiac surgery backup were relatively lower than that with cardiac surgery backup.3.Intervention comparison:the proportion of the group without cardiac surgery backup through brachial artery/ulnar artery pathways was less than that with cardiac surgery backup(0.0%V2.8%,P=0.001).The rest showed no significant differences (P＞0.05).4.Clinical outcomes comparison during in-hospital period and at 30d follow-up: the procedural success rate of the two groups(96.4%V95.2%,P=0.371);incidence rate of PCI main complications(0.8%V1.4%,P=0.511);in-hospital death (0.0%V0.5%,P=0.501);incidence rate of acute myocardial infarction(0.0%V0.0%); incidence rate of transfer for urgent cardiac surgeries(0.0%V0.2%,P=1.000); incidence rate of acute coronary closure(0.0%V0.2%,P=1.000);incidence rate of coronary artery dissection(0.3%V0.0%,P=0.474);incidence rates of coronary artery perforation/coronary artery rupture/pericardium tamponade(0.0%V0.7%,P=0.251) and the incidence rate of 30d MACE(0.3%V0.3%,P=1.00).The two groups showed no significant differences(P＞0.05).Conclusions:1.Hospitals without cardiac surgery backup can safely and effectively perform elective percutaneous coronary intervention(PCI) on low-risk cases.2.The high-volume operator going to the center of low-volume for performing PCI is feasible.