Simeon Margolis, M.D., Ph.D ,
Hospitals with onsite surgical backup are the preferred site for elective angioplasty procedures, according to guidelines from the American College of Cardiology, the American Heart Association, and the Society for Coronary Angiography and Interventions (SCAT).
That's because surgery may be required to successfully handle complications that can arise during or immediately after the procedure.
As of this writing, only nine states (Alaska, Arkansas, Delaware, Georgia, Mississippi, North Dakota, Rhode Island, South Dakota, and Vermont) and the District of Columbia prohibit hospitals without this surgical safety net from performing angioplasties. Yet the number of complications related to angioplasty — and thus the number of obligatory surgical interventions — have been growing in the U.S. and abroad.
New SCAT guidelines emphasize that only experienced and expert cardiologists should do angioplasties without surgical backup. They state that cardiologists, after completing their fellowship training, should not begin to work at a facility lacking such backup services unless they have already carried out more than 500 angioplasties as the primary operator. In addition, to remain eligible to intervene without a surgical safety net, a cardiologist should perform a minimum of 100 procedures each year.
Another SCAT recommendation strikes home with me in this day of growing competition among hospitals and the lucrative income potential of angioplasty procedures. The guideline states that the decision to start an angioplasty program without surgical backup should be based on the health needs of an area and "not on desires for personal or institutional financial gain, prestige, market share, or other similar motives."
One member of the SCAT committee that formulated the guidelines stated his preference with splendid honesty: Should he ever need an angioplasty, he would want "the best cardiac surgeon and cardiac anesthesiologist in the world standing by during my procedure and a fully-staffed operating room immediately available, just waiting for my arrival should percutaneous coronary interventions fail."
Of course, neither he nor you nor I can hope to have this level of surgical backup, but I urge you to consider the experience and success rate of the in-house cardiologist before you choose elective angioplasty at a center without a surgical safety net.