《美三大学会发布新版PCI专家共识》内容简介：

    2014年3月17日，美国SCAI/ACC/AHA三大学会在线发布了没有现场外科手术支持的经皮冠状动脉介入（PCI）专家共识的更新文件。该共识文件（指南）对过去十年中PCI的进展进行了回顾，提出了多项新的建议，是对2007年SCAI文件的更新，而后者是该领域的第一个共识文件。该文件同时发表于《Catheterization & Cardiovascular Interventions》、《the Journal of the American College of Cardiology》和《Circulation》。

    指南的主要制订者之一Gregory Dehmer博士在新闻发布会上指出，新的推荐旨在为患者提供优质医疗和护理服务的同时增加安全性，在没有现场外科手术支持的情况下，PCI应该怎么做，如何做的更好。Dehmer等写道，自2007年指南发布后共有11项原始研究和3项Meta分析发表。同一时期，美国允许进行择期和急诊PCI的州增加了60%,达到了45个；在没有心脏外科在场（PCI without on-site surgery）的情况下禁止PCI的州从10个减少到1个。

    《美三大学会发布新版PCI专家共识》内容预览：

    4SCAI/ACC/AHA 2014 PCI

    Without On-Site Surgery ECDhad no on-site surgery, and among these, 65% （282 facilities） had an annual case volume of≤200 PCI procedures.Across the US, PCI without on-site surgery has increased since 2007. The writingcommittee assessed the current use of PCI without on-site surgery from a survey of ACCGovernors for each state, data from industry sources and direct contact with physicians invarious states （Fig. 2）。

    Currently, 45 states allow both primary and elective PCI without on-site surgery, 4 states allow only primary PCI without on-site surgery, and 1 state prohibitsPCI without on-site surgery. PCI without on-site surgery is regulated by the State Departmentof Health in 34 states but is unregulated in the remaining 16 states.

    Elective PCI without on-site surgery was allowed at selected facilities in 9 states but only as part of statewidedemonstration projects or to allow participation in the Cardiovascular Patient OutcomesResearch Team （CPORT） Nonprimary PCI （CPORT-E） trial [9]. Since the conclusion ofCPORT-E, the use of PCI without on-site surgery is being revaluated in several of thesestates. PCI without on-site surgery is currently performed in 19 of the 65 cardiaccatheterization laboratories within the Veterans Health Administration [10].Recent Literature on PCI Without On-site SurgerySince 2006, 11 original studies and 3 meta-**yses on the topic of PCI without on-sitesurgery have been identified by a computerized systematic literature search using Medline（PubMed and Ovid） and Cochrane Databases [9,11–23].Primary PCI without on-site surgery. Seven studies and 2 meta-**yses of primary PCIshowed no difference for in-hospital or 30-day mortality between sites with and without on-site surgery （Table 1）。 None of the individual studies examining the occurrence of emergencyCABG surgery after primary PCI showed a difference between sites with and without on-sitesurgery. However, 1 meta-**ysis showed that sites without on-site surgery had a lowerDownloaded From: http://content.onlinejacc.org/ on 03/17/2014gui

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