Richardson S G, Morton P, Murtagh J G, O'Keeffe D B, Murphy P, Scott M E
Cardiac Unit, Belfast City Hospital.
BMJ. 1990 Feb 10;300(6721):355-8. doi: 10.1136/bmj.300.6721.355.
To determine whether percutaneous transluminal coronary angioplasty may be safely performed in cardiology centres in the United Kingdom without immediate on site cardiac surgical cover for complications arising at angioplasty.
Retrospective review of coronary angioplasties and complications in a hospital without on site cardiac surgical cover.
All angioplasties were performed in the catheterisation laboratory of the Belfast City Hospital. Revascularisation surgery for complicated coronary angioplasty was performed in the cardiac surgical unit of the Royal Victoria Hospital, 2.4 km away from the catheterisation laboratory.
540 Coronary angioplasties were performed on 512 patients between late 1982 and November 1988. Indications included stable angina, unstable rest angina, and suitable coronary disease at coronary arteriography after myocardial infarction.
In hospital mortality after complicated coronary angioplasty and delay to surgical revascularisation after acute coronary occlusion at angioplasty.
Coronary angioplasty was successful in 444 cases (82%). Acute coronary occlusion occurred in 35 cases (6.5%). Twelve patients required urgent revascularisation surgery and were transferred safely to the surgical unit; none of these patients died. A mean delay of 268 minutes (range 180-390 minutes) occurred before revascularisation compared with 273 minutes (range 108-420 minutes) in the Royal Victoria Hospital, where on site surgical cover was available. The principal cause of delay was the wait for a cardiac operating theatre to become available and not the transfer time between hospitals. Five deaths occurred after coronary angioplasty, a mortality of 0.9%. Three deaths were related to acute coronary occlusion. The absence of immediate surgical help did not influence the outcome in any patient.
With careful selection of patients coronary angioplasty may be safely performed in a hospital without on site cardiac surgical facilities, provided that these are available at a nearby centre.
确定在英国的心脏病中心，在没有针对血管成形术并发症的即时现场心脏外科支持的情况下，经皮腔内冠状动脉血管成形术是否可以安全进行。
对一家没有现场心脏外科支持的医院的冠状动脉血管成形术及其并发症进行回顾性研究。
所有血管成形术均在贝尔法斯特市医院的导管室进行。复杂冠状动脉血管成形术的血运重建手术在距离导管室2.4公里的皇家维多利亚医院心脏外科进行。
1982年末至1988年11月期间，对512例患者进行了540次冠状动脉血管成形术。适应症包括稳定型心绞痛、不稳定型静息性心绞痛以及心肌梗死后冠状动脉造影显示的合适冠状动脉疾病。
复杂冠状动脉血管成形术后的住院死亡率以及血管成形术急性冠状动脉闭塞后至手术血运重建的延迟时间。
冠状动脉血管成形术成功444例（82%）。急性冠状动脉闭塞35例（6.5%）。12例患者需要紧急血运重建手术，并安全转运至外科；这些患者均无死亡。血运重建前平均延迟268分钟（范围180 - 390分钟），而在有现场外科支持的皇家维多利亚医院，延迟时间为平均273分钟（范围108 - 420分钟）。延迟的主要原因是等待心脏手术室可用，而非医院之间的转运时间。冠状动脉血管成形术后有5例死亡，死亡率为0.9%。3例死亡与急性冠状动脉闭塞有关。即时手术帮助的缺失未对任何患者的结局产生影响。
通过仔细选择患者，在没有现场心脏外科设施的医院也可以安全地进行冠状动脉血管成形术，前提是附近中心有此类设施。
