In-hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention in Peri-urban Area Hospital Without Cardiac Surgery Backup

Introduction: In centers without cardiac surgery backup, current guidelines recommend to conduct emergency percutaneous coronary intervention and discourage elective percutaneous coronary intervention. The objective of the study was to evaluate the feasibility and safety of percutaneous coronary intervention in patients with stable coronary artery disease, acute coronary syndrome, and ST segment elevation myocardial infarction in periurban area of Nepal without on-site cardiac surgical facilities. Methods: This retrospective single-centered study was done at College of Medical Sciences, Bharatpur, Nepal. The study included 600 patients who underwent percutaneous coronary intervention in the cardiology department cath lab from January 2014 to March 2020. Patients were evaluated for in-hospital outcomes, procedural success and post percutaneous coronary intervention complications within seven days of hospital stay. Results: Seventy percent (n=420) of percutaneous coronary intervention was emergency percutaneous coronary intervention for acute coronary syndrome and 30% (n=180) of percutaneous coronary intervention was done as an elective percutaneous coronary intervention for stable angina. Procedural success was 98% (n=176) for elective percutaneous coronary intervention and 93% (n=390) for emergency percutaneous coronary intervention. Sixteen percent (n=96) patients developed acute kidney injury, six percent (n=36) of patients developed pulmonary edema and cardiogenic shock respectively, 2% (n=12) patients developed post percutaneous coronary intervention myocardial infarction, 3% (n=18) patients developed bleeding complications, 0.5% (n=3) patients developed stroke and death rate was 3% (n=18). Conclusion: Percutaneous coronary intervention can be done with comparable and acceptable safety in peri-urban area hospital of Nepal without cardiac surgery backup with dedicated and experienced team