Although accepted in several countries, in the US the performance of percutaneous coronary intervention (PCI) without on-site surgical back-up remains controversial. The current US guidelines do not endorse elective PCI in facilities without on-site surgical back-up, but acknowledge that primary PCI for ST-segment elevation myocardial infarction (STEMI) is acceptable under carefully regulated and monitored circumstances. In the US, survey data indicate that either primary PCI alone or primary and elective PCI without on-site surgery is currently being performed in all but seven states, and the number of patients treated in this setting is increasing. Several recent reports continue to document the safety of PCI without on-site surgical back-up, but have limitations as these data are from retrospective reviews or prospective registries. Although it appears that primary and elective PCI without on-site surgery is safe, it is not clear that this is the best way to deliver PCI care to the majority of patients.
TEMPORAL TRENDS AND CONTEMPORARY USE OF MULTIVESSEL PERCUTANEOUS CORONARY REVASCULARIZATION FOR ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN THE US: AN NCDR RESEARCH TO PRACTICE (R2P) PROJECT