SCAI Consensus on PCI Without On-Site Surgical Backup: Key Points
- Grines CL, Box LC, Mamas MA, et al.
- SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup. JACC Cardiovasc Interv 2023;Jan 30:[Epub ahead of print].
The following are key points to remember from a Society for Cardiovascular Angiography and Interventions (SCAI) Expert Consensus Statement on percutaneous coronary intervention (PCI) without on-site surgical backup:
- Once considered high risk and below the standard of care, PCI without surgery on site (SOS) backup has been performed with acceptable outcomes since the 1980s.
- Furthermore, elective PCI in settings without SOS has increased in volume and complexity (extending beyond the simple lesion recommendations in the 2014 SCAI consensus document on PCI without SOS document).
- In addition, PCI is now being performed outside the hospital setting, in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs).
- Several new studies in the United States and abroad have demonstrated that PCIs performed at non-SOS centers have very low rates of complications and similar outcomes to PCIs performed at surgical centers.
- Despite increases in age, comorbidities, and lesion complexity, the rate of periprocedural complications has remained constant, or declined, with rates of emergency surgery as low as 0.1% in many series.
- Complex PCI, including unprotected left main, is being performed at some non-SOS centers, with no increase in major adverse cardiovascular events or emergency coronary artery bypass graft surgery compared with PCI at surgical centers.
- While there have been no comparative studies in other complex PCI subgroups, such as chronic total occlusion and atherectomy, observational studies demonstrate reasonable outcomes and suggest feasibility with experienced interventional cardiologists.
- The current consensus document proposes a new algorithm that takes into account not only patients’ clinical risk and lesion risk but also the rescue capabilities of the site.
- Equally important is the experience (both recent and accumulated) of the interventional cardiologists on site, as such experience is essential for accurate risk assessment, complication identification and management, and knowledge of rescue options. Adequate operator experience, appropriate clinical judgment and case selection, and facility preparation are essential to a safe and successful PCI program without SOS.
- Of note, in the United States, there are considerable financial savings (to insurers and Medicare) for PCI to be performed at ASCs and OBLs, so out-migration of procedures from hospitals should be anticipated.
Keywords: Ambulatory Surgical Procedures, Atherectomy, Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Occlusion, Cost Savings, Myocardial Ischemia, Percutaneous Coronary Intervention, Risk Assessment, Treatment Outcome
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