This discussion is not essential following a heart attack. "However, in the non-heart attack setting, it would be reasonable to ask this question," Kinlay said. "At the time the guidelines were written, there was still some doubt about whether on-site [surgery] is a necessity," he added.
Many of the studies only recruited and included patients who are considered low risk. If ongoing trials "come to the same conclusion as this paper, future guidelines may suggest that patients with high-risk features" should have their angioplasty in a hospital with on-site bypass, whereas "[angioplasty] without on-site [bypass] may be more acceptable for the majority of average and low-risk patients," Kinlay noted.
"We should wait for further confirmation by the randomized trials before giving the absolute green light on this," Kinlay said, particularly as these studies may also help define who should have angioplasty in hospitals with on-site bypass surgery.
Visit the U.S. National Heart, Lung, and Blood Institute to learn more about angioplasty.
SOURCES: Mandeep Singh, M.D., M.P.H., cardiologist, Mayo Clinic, Rochester, Minn.; Scott Kinlay, M.D., MBBS, Ph.D., director, cardiac catheterization laboratory and vascular medicine, VA Boston Healthcare System, West Roxbury, Mass.; Dec. 14, 2011, Journal of the American Medical Association
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