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New code of conduct for angioplasty centers

SCAI releases the first ever guidelines for stand-alone angioplasty centers, reports Sanchita Sharma.

india Updated: Feb 07, 2007 17:59 IST

The International Society for Cardiovascular Angioplasty and Interventions (SCAI) has released the first ever guidelines for stand-alone angioplasty centers, with a benchmark of the medical skills and emergency support staff these centres must ensure.

Currently, angioplasty - also called percutaneous coronary intervention (PCI) - is being performed without surgical backup in most nations including India.

"The report strongly recommends that PCI should be performed in centres that have an experienced surgical team available as emergency backup for all procedures," Dr Ashok Seth, chairman and chief cardiologist at the Max Devki Devi Heart and Vascular Institute, told the Hindustan Times. "However, since centres without on-site surgical backup are a reality, the SCAI decided to issue guidelines to regulate them."

Seth was part of the nine-member international team that drafted the guidelines. The new guidelines have been published in the current issue of the journal Catherization and Cardiovascular Interventions.

Angioplasty includes non-surgical procedures used to treat patients with clogged arteries that reduce blood flow to the heart. It is also used to prevent a heart attack caused by a large blood clot completely blocking the artery.

Typically, angioplasty involves threading a slender balloon-tipped tube called a catheter to the arterial blockage from an artery in the groin or arm. The balloon is then inflated to push back the plaque (fatty deposits in the inner wall of the blood vessel) against the arterial wall to allow the blood to flow more easily. Angioplasty is usually accompanied with the insertion of an expandable metal stent, which is a wire mesh tube that expands to keep the artery propped open.

If you need an angioplasty, here's the checklist:

· Interventions in centres without surgical backup should not be done on highrisk patients. These include patients with more than 50 per cent blockage of the left main artery; long, calcified or severely angulated lesions; congestive heart failure; left ventricular pumping capacity of less than 25 per cent; or those with over three-vessel blockage
· The facility should have experienced doctors and support staff. Only doctors with success rates equivalent or superior to national benchmarks should perform interventions.
· There should be rigorous data collection, outcomes analysis and case review. Data on the success and failures should be sent to the national data registry, where available.
· Learning new skills through continuing medical education should be mandatory
· The doctors should have performed over 500 angioplasties as the main operator.
· Emergency transfer of patients to a heart surgery centre should be provided and tested twice a year.
· The centre should perform more than 200 interventions in a year. Those with less than 200 procedures should be reviewed individually and should be allowed to remain open only if they function in geographically isolated areas.

Email Sanchita Sharma: sanchita.sharma@hindustantimes.com