Should angioplasty and stent placement (PCI) be done in a hospital without on-site open heart surgery? This question is plaguing the entire United States right now. However, when you are an island in the middle of the Caribbean Sea and you do not have an open heart surgery program, then PCI or thrombolytics could be the only choices that your patients may have to survive.
In June 2000, a cardiovascular laboratory was opened at the Governor Juan F. Luis Hospital and Medical center in St. Croix, United States Virgin Islands. At that time, only diagnostic procedures were being conducted. However, with the diagnostic lab in place, and the continued use of TPA during acute MIs, the mortality rate for patients experiencing an MI was still on the rise. The physicians and hospital administration determined that in order to provide quality care to patients experiencing an acute MI, then an angioplasty program without on-site open heart back up would need to be established.

In March 2002, an angioplasty program was established at our facility, as Interventional Cardiologist Kendall Griffith MD, FACC, joined our team. We developed a plan for elective and emergent PCI utilizing open heart surgery in Puerto Rico, a 35-minute flight away.

This program has dramatically decreased our mortality rate, and provided better quality care to those patients experiencing an acute MI. The future plans of the cardiovascular program are currently being established and will include on-site open heart backup. In the meantime, we continue to provide PCI services without on-site open heart backup. The following is an evaluation of the program to date.