SCAI Publishes Expert Consensus Statement on PCI Without Surgery on Site

January 30, 2023—The Society for Cardiovascular Angiography & Interventions (SCAI) announced that a new expert consensus statement suggests that percutaneous coronary intervention (PCI) without surgery on site (no-SOS) is as safe as PCI at centers with on-site surgery across randomized controlled trials, observational studies, and international experiences. The statement explains that adequate operator experience, appropriate clinical judgment and case selection, and facility preparation are essential to a safe and successful PCI program with no-SOS.

Cindy L. Grines, MD, et al, published the statement online in JSCAI and JACC: Cardiovascular Interventions.

In 2007, SCAI issued an initial consensus statement on the procedure within this setting, with the last update published in 2014 by Gregory J. Dehmer, MD, et al in Journal of the American College of Cardiology (2014;63:26242641).

In the society’s press release, Dr. Grines, Chair of the writing group and SCAI Past President, commented, “Since we released the last consensus statement in 2014, same-day discharge after elective PCI has increased to 28.6% of all PCIs and 39.7% of radial PCIs in the United States. Elective PCIs in no-SOS settings have increased in volume and complexity. Concurrently, there have been operators performing PCI in office-based laboratories (OBLs) and ambulatory surgery centers (ASCs) with positive outcomes.”

Dr. Grines continued, “Thanks to improvement in PCI safety and several global studies in recent years, we now know that PCI at ASCs may improve access, patient satisfaction, and reduce costs.”

As outlined in the SCAI press release, statement highlights include:

1. Elective PCI in settings with no-SOS has increased in volume and complexity (extending beyond the simple lesion recommendations in the 2014 document). In addition, PCI is now being performed outside of the hospital setting in OBLs and ASCs.
2. Several new studies in the United States and abroad have demonstrated that PCIs performed at no-SOS centers have very low rates of complications and similar outcomes to PCIs performed at surgical centers.
3. Despite increase in age, comorbidities, and lesion complexity, the rate of periprocedural complications has remained constant or declined, with rates of emergency surgery as low as 0.1% in many series.
4. Complex PCI, including unprotected left main, is being performed in some no-SOS centers, with no increase in major adverse cardiovascular events or emergency coronary artery bypass graft surgery compared with PCI at surgical centers.
5. The SCAI writing group proposes a new PCI treatment algorithm that expands the type of cases that can be performed with no-SOS compared with the 2014 document, with consideration of patients’ clinical and lesion risk, operator experience (both recent and accumulated), and experience and rescue capabilities of the site.
6. In the United States, there are considerable financial savings (to insurers and Medicare) for PCI to be performed in ASC and OBL settings; thus, outmigration of procedures from hospitals should be anticipated.

SCAI advised that this expert consensus statement was endorsed by the American College of Cardiology, American Heart Association, British Cardiovascular Intervention Society, Canadian Association of Interventional Cardiologists, and Outpatient Endovascular and Interventional Society.

This expert consensus statement was developed according to SCAI Publications Committee policies for writing group composition, disclosure, and management of relationships with industry, internal and external review, and organizational approval. The writing group has been organized to ensure diversity of perspectives and demographics, multistakeholder representation, and appropriate balance of relationships with industry, noted the society’s press release.