• Cardiology Clinical Trials
• Interventional Techniques & Devices

Routine percutaneous coronary intervention (PCI) can be performed safely by a specially trained team of cardiologists, registered nurses, and cardiovascular technicians in a public hospital, according to findings from a pilot PCI training program. Clifford Thomas, MD, Eric Williams Medical Sciences Complex (EWMSC), Mount Hope, Trinidad and Tobago, described outcomes from the first 101 procedures that were performed as part of the pilot program at EWMSC.

With a high prevalence of coronary artery disease (CAD) and few interventional cardiologists in Trinidad and Tobago, the growing needs for PCI were not being met. Physicians at the EWMSC initiated a PCI training program for cardiologists, nurses, and technicians in September 2008. During the first 20 months of the program, 101 patients were treated.

The mean patient age was 56 years, and 69 patients (69%) were male. At the time of presentation, the mean left ventricular ejection fraction (LVEF) was 56%. The majority of patients (71%) had class III or IV angina, and one patient required primary PCI for ST-segment elevation myocardial infarction. Patients were more likely to receive drug-eluting stents than bare-metal stents. Following PCI, all patients were started on 2 years of anticoagulation therapy with clopidogrel.

All procedures met the standard of clinical success, which was defined as a combination of procedural success (<10% stenosis) with no major complications. The mean diameter stenosis was reduced from 86% at baseline to 8% after PCI. No patients required repeat revascularization during the index hospitalization, and no deaths were reported. One patient required elective coronary artery bypass grafting after PCI failed to dilate a calcified lesion.

These preliminary results support the expansion of the PCI training program, Dr. Thomas said. The program will continue to increase the number of skilled interventional cardiologists and provide increased access to PCI for public sector patients. The team is currently evaluating procedural success rates by lesion severity, as well as long-term outcomes among patients who have received treatment as part of the program.

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