ST-segment-elevation myocardial infarction treated at hospitals with and without on-site cardiac surgery: do we have the answer and what about the future?

Controversy continues in the United States over the performance of percutaneous coronary intervention (PCI) at facilities without on-site cardiac surgery. After publication of the quantitative review by Keeley et al1 in 2003, the superiority of PCI over thrombolytic therapy for the treatment of ST-segment–elevation myocardial infarction (STEMI) was widely accepted. These findings further supported primary PCI programs at hospitals without cardiac surgery in an effort to provide more rapid care for patients with STEMI in their local communities.2 This strategy was subsequently extended, with good reported results, to nonemergent and elective PCI cases in an attempt to maintain higher PCI volumes and staff expertise.3–5 However, controversy continued as the 2005 PCI Guidelines designated primary PCI a class IIb indication (may be considered) but elective PCI a class III indication (not recommended) in hospitals that did not have cardiac surgery on site.6