Percutaneous coronary interventions (PCI) were introduced by Andreas Gruntzig in 1979 and initially performed for stable angina pectoris due to a discrete lesion in a proximal coronary artery. The early experience by Gruntzig et al. demonstrated the potential success of this new therapy; however, the two well-recognised caveats were immediate vessel occlusion due to balloon-induced obstructive dissections and late restenosis. The occurrence of an obstructive dissection mandated the presence of onsite cardiac surgery in the early years after the introduction of PCI. Umans et al. reported the first Dutch results of surgery following a failed percutaneous transluminal coronary angioplasty (PTCA) in 1984 showing an incidence of 9%.
1,2 A dramatic decline in the need for cardiac surgery as a result of an acute vessel occlusion occurred after the introduction of the intracoronary stent by Sigwart et al.
3 Zijlstra et al. reported on the role of cardiac surgery in the 1990s in the large Zwolle experience.
4 The incidence of emergency coronary artery surgery after PCI further declined to 0.14-0.3% with increasing operator experience and improved wire, balloon and stent design.
5,6 This improvement of PCI outcome led to an increase in PCI procedures encompassing the total spectrum of the coronary artery disease. Additionally, PCI was performed in centres without on-site cardiac surgery. Subsequently new guidelines were accepted including the possibility of performing PCI in an off-site centre. Based on experience from other countries, the Medical Centre Alkmaar was granted permission to start the first Dutch PCI programme without on-site cardiac surgery. In 2002, the cardiology group of the Medical Centre Alkmaar started an off-site PCI programme with only primary PCI in the first year and a full PCI programme from November 2003 onwards. We report the first Dutch experience with acute cardiac surgery following a failed PCI procedure in an off-site clinic. …
