Background
Cardiac Society of Australia and New Zealand (CSANZ) guidelines recommend elective
high-risk percutaneous coronary intervention (PCI) is not performed in sites greater
than 1 hour from cardiac surgery.
Methods
In hospital outcomes for all patients from Orange Health Service (OHS) from January
2017 to January 2020 who were transferred electively to tertiary centres in Sydney
for high risk PCI were examined.
Results
One hundred and fourteen (114) patients were identified, with 1,259 PCIs performed
at OHS over the same period without transfer. The mean age of these 114 patients was
71 years, with 74.6% male. Receiving hospitals were Royal Prince Alfred Hospital,
Sydney, NSW (66.7%), Concord Repatriation General Hospital, Concord, NSW (19.3%) and
Strathfield Private Hospital, Strathfield, NSW (14%). The definition of high risk
and indication for transfer included at least one of: moderate or greater calcification
of the target lesion or proximal segment (34%), single or multiple target lesions
that in aggregate jeopardised over 50% of remaining viable myocardium (27%), degenerated
saphenous vein grafts (14.8%), chronic total occlusions (7.0%) and severe left ventricular
(LV) impairment (3.9%). American Heart Society/American College of Cardiology (AHA/ACC)
lesion types were A (1%), B1 (4.2%), B2 (40.2%), and C (54.6%). PCI was performed
via the femoral route in 96.2%. The mean procedure duration was 72 minutes, mean combined
fluoroscopy time was 19 minutes and mean radiation dose as defined by Reference Air
Kerma was 1,630 mGy. Complications occurred in 13 patients and were: acute vessel
dissection requiring stenting (4), perforation (2), acute vessel closure (4), puncture
site related (1), and life-threatening arrhythmia (2). There were no cases of emergent
coronary artery bypass graft (CABG) or death.
Conclusion
This contemporary cohort of high-risk patients transferred electively from a regional
PCI centre to a tertiary cardiac unit underwent lengthy PCI procedures, with high
radiation doses, and a modest rate of peri-procedural complications, but had otherwise
excellent procedural and clinical outcomes.
Keywords
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Article info
Publication history
Published online: August 12, 2021
Accepted:
July 2,
2021
Received in revised form:
March 23,
2021
Received:
June 14,
2020
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
