Although percutaneous coronary interventions are becoming more popular than ever, many states still require that a cardiothoracic surgeon be ready to operate in the event of complications. Dr. Michael Kutcher and colleagues at Wake Forest University report new data this week, however, that suggests this is an unnecessary precaution, and that cardiologists can safely perform PCIs at centers that don’t even have cardiothoracic surgeons on staff, as long as they’re relatively close to a center that does.

The findings are good news for small hospitals, since PCIs are in high demand and are major money-makers. The findings are bad news for cardiothoracic surgeons, who are struggling to remain relevant. 

At present, all hospitals without on-site surgical support can perform PCIs in emergency situations, but the official recommendation is against performing them on an elective basis. In some states, the latter is not permitted at all. The hospitals argue, however, that it is financially untenable for them to maintain cath labs without taking elective cases.

Kutcher found that rates of PCI success, overall complications, and need for emergency surgery were the same in centers with and without onsite surgical staff. When complications did arise, outcomes from emergency surgical procedures were the same whether these were performed onsite or at the nearest major center.

In a press release, Dr. Kutcher warns that these findings should not be taken as an endorsement of “boutique” angioplasty suites, but rather an affirmation of the good work being performed at many small hospitals in remote areas. “They’re are doing angioplasty for the right reasons,” he said, which are “to improve outcomes for heart attack patients and to better serve patients in remote geographic areas.”