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Heart. 2007 December; 93(12): 1619.
PMCID: PMC2095731

PCI with or without surgical standby

To the Editor: We congratulate Dr Carlsson et al on their work on the safety of percutaneous coronary interventions (PCI) in an hospital with or without on‐site cardiac surgery standby,1 albeit their study raises several concerns.

First, the majority of patients(nearly 80%) had one‐ or two‐vessel disease and as depicted in table 2 in their paper only around 15% of patients had two or more vessels treated. No fundamental data as to the type of culprit vessels (whether left anterior descending coronary artery or posterior descending coronary artery or a minor diagonal branch) or the baseline ejection fraction were provided in the study.

The data on the deaths after emergent coronary artery bypass grafting (CABG) in the two groups are quite confusing as reported by the authors in last paragraph of the “Results” section; moreover, there is no clear specification about the percentage of patients undergoing emergency CABG with a myocardial infarction in <24 hours. This fundamental factor may yield an almost doubled predicted operative mortality(16% vs 6%) in such a specific group of patients, as previously reported by other authors.2 According to the higher rate of patients with ST‐segment elevation myocardial infarction in centres with on‐site cardiac surgeons, it is more than likely that these high‐risk patients underwent CABG.

Finally, the following statement in the Discussion is questionable: “…The presented data of contemporary practice could not show significant differences with respect to adjusted outcome variables…”,1 since the authors themselves in table 3 and in fig 2 (Kaplan–Meier long‐term mortality) depict that their results are non‐adjusted.

In conclusion, we believe that the study by Dr Carlsson et al does not fairly represent the general clinical situation of all patients undergoing PCI and the conclusions of the manuscript should be used carefully only in a selected subset of patients and not immediately adopted as a reference for the PCI guidelines as the authors suggest.

References

1. Carlsson J, James S N, Ståhle E. et al Outcome of percutaneous coronary intervention in hospitals with and without on‐site cardiac surgery standby. Heart 2007. 93335–338.338 [PMC free article] [PubMed]
2. Haan C K, O'Brien S, Edwards F H. et al Trends in emergency coronary artery bypass grafting after percutaneous coronary intervention, 1994–2003. Ann Thorac Surg 2006. 811658–1665.1665 [PubMed]

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