Elective coronary angioplasty with and without surgical standby: clinical and angiographic criteria for the selection of patients.

BACKGROUND

The cardiac catheterization laboratory (CCL) of our hospital is the only facility for invasive cardiology in a large district. No cardiac surgery is carried out in our hospital at present, the nearest facility being approximately 50 miles away.

METHODS

Over a period of 2 years we recommended percutaneous transluminal coronary angioplasty (PTCA) with surgical standby for 164 cases, who were referred to CCLs with on-site surgical standby, and PTCA without surgical standby for 232 cases, 199 of whom underwent PTCA in our CCL. Criteria used in the selection of patients for PTCA without surgical standby were the following: (a) either limited extent or severely impaired function of the ventricular segment in jeopardy; (b) normal or near-normal function of the uninvolved myocardial segments; (c) absence of lesions of the left main or left anterior descending coronary arteries when the target stenosis was in the left coronary artery; (d) non-applicability and high risk-benefit ratio of emergency surgical revascularization in the individual patient. Clinical and angiographic characteristics of patients assigned to PTCA with and without surgical standby are compared.

RESULTS

An initial success was achieved in 186 cases (93%) in our CCL. In 12 cases (6%), PTCA was not successful, and in two cases (1%) it was complicated by myocardial infarction. None of the patients died, or had to undergo further coronary interventions within 1 month. Coronary stents were implanted in 24 cases.

CONCLUSION

For many PTCA candidates, emergency coronary surgery is not an option in case of occlusive complications. Our data suggest that PTCA can be performed with minor complications in these patients in the absence of surgical standby, provided strict criteria are used in the selection of cases.