Yes, We Can! (Should We?)

Historically, percutaneous coronary intervention (PCI) was relegated to hospitals with colocated cardiac surgery because of the potential need for emergent surgical treatment of PCI-related complications. In the current issue of Circulation , Lee and colleagues1 compare outcomes of PCI at hospitals with and without on-site cardiac surgery and show that emergency cardiac surgery is, in fact, rarely needed ( 1 million patients and demonstrates that the incidence of other PCI-related complications, including myocardial infarction, stroke, cardiogenic shock, aortic dissection, and tamponade, as well as early (within 30 days) and late (after 30 days) all-cause mortality, is not different at hospitals with and without colocated cardiac surgery.1 Article see p 388 Because of inconsistencies among the studies, other outcomes indicators of quality, including the need for target vessel revascularization, could not be evaluated in detail. However, when results from the 2 randomized, controlled trials reporting target vessel revascularization (Cardiovascular Patient Outcomes Research Team Trial [CPORT-E]2 and Percutaneous Coronary Intervention [PCI] Outcomes in Community Versus Tertiary Settings [MASS COMM]3) were combined, rates of target vessel revascularization were similar at hospitals with and without on-site cardiac surgery. This important contribution confirms and puts on a more solid evidence-based foundation current guideline recommendations that allow the performance of primary and nonprimary PCI at hospitals without on-site surgery.4 Like all important studies, this report raises a number of questions. Although PCI at hospitals without on-site cardiac surgery is safe and effective, what is the motivation for extending nonprimary PCI at these facilities? What are the consequences of extending PCI to more hospitals? How should the extensive research knowledge base summarized by Lee and colleagues be applied to the development of PCI programs at hospitals without on-site cardiac surgery? The cynical view is that …