Coronary angiography and angioplasty without onsite cardio-thoracic surgical backup in a new cardiac catheterisation lab : a single-centre experience

Coronary angiography and angioplasty have previously been shown to be performed safely and successfully by experienced staff without onsite cardiothoracic surgery backup. This study aimed to report the performance of a single centre in New South Wales (NSW). Methods and Results: All consecutive patients (n = 812) who underwent angiography and or angioplasty at the cardiac catheterisation lab, between 29 August 2016 and 31 December 2017, at Campbelltown Hospital were evaluated. The lab initially performed angiography only. The angioplasty program commenced on 18 September 2017. Patients with significant coronary artery disease requiring complex angioplasty or coronary artery bypass graft (CABG) were transferred to a nearby tertiary hospital. In total, 527 patients underwent angiography during the angiography only period, and 222 patients underwent angiography with 63 angioplasties during the angioplasty period. Patient demographics included: mean age 64 ± 12 years, mean body mass index 30.6 kg/m2, 64% males, 34% with diabetes, 65% with hypertension, and 50% with dyslipidaemia. Among the procedures, 270 (33%) were performed for non-ST-elevation myocardial infarction (NSTEMI), 68 (8.4%) for unstable angina, three (0.3%) for STEMI, and 471 (58%) for stable coronary heart disease. Vascular access was obtained via radial in 542 patients (67%). A same day discharge program was implemented based on specific safety criteria. Seven patients (0.86%) had minor haematoma at the access site (0.18% radial vs 2.2% femoral, p = 0.007). One patient had localised radial artery dissection, which was managed conservatively. There were no major adverse cardiac events (death, myocardial infarction, major bleeding or stroke), or emergency surgery. Conclusion: Favourable clinical outcomes with minimal complications were experienced during the first year. These results were consistent with previously published data from other NSW centres