Safety of PCI at Hospitals Without On-Site Cardiac Surgery

The need for emergency coronary artery bypass grafting after percutaneous coronary intervention (PCI) has steadily declined over the past 3 decades, particularly since coronary stents became available. To determine whether the absence of surgical backup affects outcomes of contemporary PCI, investigators conducted the CPORT-E trial at 60 hospitals without on-site cardiac surgical capability. After diagnostic catheterization, participants were randomized 3:1 to undergo nonprimary PCI at the same hospital or at a hospital with backup cardiac surgical facilities. Although high-risk patients (including those with ST-segment-elevation myocardial infarction [MI], ejection fractions of less than 20%, or unprotected left main lesions) were excluded…