SCAI sets high standards for PCI without on-site cardiac surgical backup
The Society for Cardiovascular Angiography and Interventions (SCAI), a leading organization for interventional cardiologists, today released a document recommending the adoption of stringent quality standards by those who perform percutaneous coronary intervention (PCI) in hospitals not equipped for cardiac surgery. The document has been endorsed by 12 medical societies representing more than a dozen countries, including the Asia-Pacific region, Australia, Belgium, Brazil, Bulgaria, Egypt, Great Britain, India, Italy, Latvia, New Zealand, Poland, and Venezuela.
The document, which represents the consensus of a panel of experts in interventional cardiology, acknowledges that an increasing number of patients suffering from heart attack or coronary artery disease are undergoing stenting and other catheter-based heart therapies in hospitals without on-site cardiac surgery, both in the United States and around the world. When PCI is performed without on-site surgical back-up, physicians and hospitals should adhere to the highest standards of quality to ensure patient safety and excellent clinical outcomes, the document recommends.
"This is not an open endorsement of PCI without on-site surgical back-up. Instead, we are acknowledging that it may be appropriate in some settings, and offering our expert consensus on how such programs should be organized, supervised, and performed," said Dr. Gregory J. Dehmer, SCAI President and chair of the expert panel. "The goal is to improve the quality of coronary interventional care worldwide."
The consensus document recommends that PCI programs operating without on-site cardiac surgery:
- Maintain case volumes of at least 200 PCIs per year;
- Employ highly skilled interventional cardiologists who have performed more than 500 PCIs throughout their career, have an annual case volume of more than 100 PCIs, and meet national benchmarks for procedural success and complication rates;
- Train all support personnel in the management of PCI patients;
- Select patients carefully to control the risk of complications;
- Establish a close alliance with cardiovascular surgeons, including formalized and tested protocols for emergency transfer of patients;
- Activate emergency transport at the first clear signs of a PCI complication, thereby ensuring that the time to the initiation of cardiopulmonary bypass does not exceed 120 minutes; and
- Collect appropriate outcomes data and submit them for comparison with state or national performance standards.
The consensus document addresses an ongoing health policy debate. Current PCI guidelines