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SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Endorsement: This expert consensus statement was endorsed by the American College of Cardiology (ACC), British Cardiovascular Intervention Society (BCIS), Canadian Association of Interventional Cardiologists (CAIC), and Outpatient Endovascular and Interventional Society (OEIS).

Although once considered high-risk and below the standard of care, percutaneous coronary intervention (PCI) without on-site surgical backup has been performed with acceptable outcomes since the 1980s.1 An initial consensus document on PCI without surgery on site (no-SOS) was published by Society for Cardiovascular Angiography & Interventions (SCAI) in 2007 and updated in 2014.2,3 The 2014 document summarized new literature, reviewed existing guidelines and other publications related to PCI with no-SOS, and recommended best practices and requirements for facilities performing PCI with no-SOS. At the time, the research and practice of PCI with no-SOS were still limited, and as a result, the recommendations for case selection and practice were conservative.

Since the publication of the 2014 consensus statement, same-day discharge after elective PCI has increased to 28.6% of all PCIs and 39.7% of radial PCIs in the United States in 2017.4 Elective PCI in no-SOS settings has increased in volume and complexity. Concurrently, there have been interventional cardiologists performing PCI in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs). Although comprising a small percentage of annual PCI procedures, this setting has garnered increased attention, notably with the 2020 expansion of coverage by the US Centers for Medicare & Medicaid Services (CMS) to include PCI in the ASC setting.5 PCI at ASCs may improve access, patient satisfaction, and reduce costs. Several new studies in the United States and abroad have demonstrated that PCIs performed at no-SOS centers have very low rates of complications and similar outcomes to PCIs performed with surgery on site. Moreover, recent consolidation of surgical services within health systems have resulted in some well-established, experienced, and high-quality PCI centers being restricted from performing complex PCI because of the perceived need for on-site surgery.

Thus, the writing committee has revised the 2014 document to (1) update the available data, (2) reconsider the types of cases that could be undertaken without on-site surgical backup, (3) review data regarding which patients are at higher risk, and (4) recommend patient selection criteria based on patient risk, operator experience, and facility capabilities. Importantly, as PCI with no-SOS is often the predominant mode of delivery globally, we expanded the document to include international experience, perspectives, and outcomes.

Click here to read full text: https://www.jscai.org/article/S2772-9303(22)00600-7/fulltext

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