Requirements to perform coronary interventions at hospitals without coronary surgery. Guidelines of the Spanish Society of Cardiology

During the early years of coronary interventions a rigorous on-site surgica l stand-by was mandatory. The increased experience in coronary angioplasty both on total number of procedures and the experience gained by each operat or, together with the technical improvements, namely since the introduction of stents has induced an evolution in the stand-by strategy, with new conc epts such as "next available operating room" or coronary interventions "wit hout on site" surgical facilities, are gaining widespread acceptance. With the aim of defining the requirements to perform coronary interventions at hospitals without coronary surgery, the following aspects are reviewed: a) complications following coronary angioplasty that require coronary surg ery; b) the current status of coronary angioplasty without surgical stand-b y in different countries. All this information allows us to advance some re commendations concerning the performance of coronary interventions at hospi tals without onsite cardiac surgery. Different issues including hospital ch aracteristics, operator and cardiac catheterization laboratory requirements , as well as lesion characteristics and the type of informed consent, shoul d be taken into acccount.