Percutaneous Coronary Intervention Without On-Site Surgical Backup

Publication Date: January 30, 2023
Last Updated: January 31, 2023


  1. Elective percutaneous coronary intervention (PCI) in settings without surgery on site (no-SOS) has increased in volume and complexity (extending beyond the simple lesion recommendations in the 2014 document). In addition, PCI is now being performed outside of the hospital setting, in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs).
  2. 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 at surgical centers.
  3. Despite increase in age, comorbidities, and lesion complexity, the rate of periprocedural complications has remained constant, or declined, with rates of emergency surgery as low as 0.1% in many series.
  4. Complex PCI, including unprotected left main, is being performed in some no-SOS centers, with no increase in major adverse cardiovascular events or emergency coronary artery bypass graft surgery compared with PCI at surgical centers. There have been no comparative studies in other complex PCI subgroups such as chronic total occlusion and atherectomy; however, observational studies demonstrate reasonable outcomes and suggest feasibility with experienced interventional cardiologists.
  5. We propose a new PCI treatment algorithm (Figure 1) that expands the type of cases that can be performed with no-SOS compared with the 2014 document, with consideration of the patients’ clinical and lesion risk, operator experience (both recent and accumulated), and the experience and rescue capabilities of the site.
  6. In the United States, there are considerable financial savings (to insurers and Medicare) for PCI to be performed in ASC and OBL settings, thus out-migration of procedures from hospitals should be anticipated.



Percutaneous Coronary Intervention Without On-Site Surgical Backup

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