|1. The operators must be experienced interventionalists who regularly perform elective intervention at a surgical center (≥75 cases/year). The institution must perform a minimum of 36 primary PCI procedures per year.|
|2. The nursing and technical catheterization laboratory staff must be experienced in handling acutely ill patients and comfortable with interventional equipment. They must have acquired experience in dedicated interventional laboratories at a surgical center. They participate in a 24-h, 365-day call schedule.|
|3. The catheterization laboratory itself must be well-equipped, with optimal imaging systems, resuscitative equipment, intra-aortic. balloon pump (IABP) support, and must be well-stocked with a broad array of interventional equipment.|
|4. The cardiac care unit nurses must be adept in hemodynamic monitoring and IABP management.|
|5. The hospital administration must fully support the program and enable the fulfillment of the above institutional requirements.|
|6. There must be formalized written protocols in place for immediate (within 1 h) and efficient transfer of patients to the nearest cardiac surgical facility which are reviewed/tested on a regular (quarterly) basis.|
|7. Primary intervention must be performed routinely as the treatment of choice around the clock for a large proportion of patients with AMI, to ensure streamlined care paths and increased case volumes.|
|8. Case selection for the performance of primary angioplasty must be rigorous. Criteria for the types of lesions appropriate for primary angioplasty and for the selection for transfer for emergent aortocoronary bypass surgery are shown in Table 10.|
|9. There must be an ongoing program of outcomes analysis and formalized periodic case review.|
|10. Institutions should participate in a 3- to 6-month period of implementation during which time development of a formalized primary PCI program is instituted that includes establishing standards, training staff, detailed logistic development, and creation of a quality assessment and error management system.|
↵legend Adapted with permission from Wharton TP Jr, McNamara NS, Fedele FA, Jacobs MI, Gladstone AR, Funk EJ. Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery. J Am Coll Cardiol 1999;33:1257–65.
legend AMI = acute myocardial infarction; IABP = intra-aortic balloon pump; PCI = percutaneous coronary intervention.