Consensus statement suggests PCI without surgery on site is as safe as PCI with surgery on site

A new expert consensus statement from the Society for Cardiovascular Angiography & Interventions (SCAI) states that across randomized controlled trials, no-SOS percutaneous coronary intervention (PCI) is It suggests that it is as safe as PCI in a surgical center. Observational studies, and international experience.

The statement issued today Journal of Cardiovascular Imaging and Interventional Society (JSCAI) When JACC: Cardiovascular interventionexplained that adequate operator experience, good clinical judgment and case selection, and site readiness are essential to a safe and successful PCI program without SOS.

PCI is an interventional procedure performed through a skin puncture or small incision (percutaneous), rather than surgery, in one or more arteries to the heart (coronary arteries). PCI with no-SOS was once considered high-risk, but has been performed with acceptable results for nearly 40 years. In 2007, SCAI issued its first consensus statement on procedures within this setting, with the last update in 2014.

“Since issuing the last consensus statement in 2014, same-day discharge after elective PCI has increased to 28.6% of all PCI and 39.7% of radial PCI in the United States,” wrote group and former president of SCAI.

“Elective PCI in a no-SOS setting is increasing in volume and complexity. We have an operator.”

“Thanks to the improved safety of PCI and several recent global studies, we know that PCI in ASC can improve access, patient satisfaction and reduce costs.”

Statement highlights:

1. Elective PCI in the no-SOS setting is increasing in volume and complexity (extending beyond the simple lesion recommendations of the 2014 document). Additionally, PCI is currently performed outside of the hospital environment, in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs).
2. Several new studies in the United States and abroad have shown that PCI performed in no-SOS centers has very low complication rates and results similar to PCI performed in surgical centers. It has been.
3. Despite increasing age, comorbidities, and lesion complexity, the incidence of perioperative complications has remained constant or declining, with emergency surgery rates as low as 0.1% in many series .
4. Complex PCI involving unprotected left mains is performed in some no-SOS centers and is associated with an increase in major cardiovascular events and emergency coronary artery bypass graft surgery compared with PCI in surgical centers. is not.
5. The SCAI writing group considers the patient’s clinical and lesion risk, the operator’s experience (recent and accumulated), and developed a new study that expands the types of cases that can be performed with no-SOS compared to the 2014 document. We propose a PCI treatment algorithm. and field experience and rescue capabilities.
6. Considerable economic savings (for insurance companies and Medicare) are possible in the United States by performing PCI in ASC and OBL settings, so a shift in procedures from hospitals is expected.

This expert consensus statement was prepared in accordance with the SCAI Publishing Committee’s policy for writing group composition, disclosure, and management of industry relations, internal and external review, and institutional approval. Writing groups are organized to ensure the right balance of perspective and demographic diversity, multi-stakeholder representation, and industry relationships. Relevant author disclosures are included as supplements to the manuscript.

This expert consensus statement is endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the British Association for Cardiovascular Interventions (BCIS), the Canadian Association for Interventional Cardiology (CAIC), and the Society for Outpatient Endovascular Care. (OEIS) approved.