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Will having surgery on-site during my stent procedure lower my risk of dying in 30 days?

high confidence  ·  Last reviewed May 9, 2026

You are asking whether having a cardiac surgery team on-site (surgical backup) during your stent procedure (percutaneous coronary intervention, or PCI) reduces the chance of death within 30 days. This is a common concern, but the best available evidence shows that 30-day mortality is similar whether the procedure is done at a hospital with on-site surgery or without. A large meta-analysis of 22 studies involving over 2 million patients found no significant difference in 30-day death rates between hospitals with and without on-site surgical backup 5. Other studies focusing on high-risk patients, such as those with left main coronary artery disease or acute coronary syndromes, also report that procedures without on-site surgery can be performed safely, with low rates of emergency bypass surgery and acceptable long-term outcomes 910.

What the research says

A 2024 meta-analysis pooled data from 22 studies (over 2 million patients) and found no significant difference in 30-day mortality between hospitals with surgical on-site (SOS) and those without (NSOS) (odds ratio 0.91, 95% CI 0.53-1.54) 5. The analysis also showed no differences in rates of heart attack, stroke, or repeat target vessel revascularization between the two settings 5. Interestingly, rates of emergency coronary artery bypass surgery (eCABG) and repeat PCI were actually higher in hospitals with on-site surgery, possibly because surgeons are more readily available to operate 5.

Studies specifically in high-risk patients support these findings. A single-center study of 70 patients undergoing left main PCI without on-site surgery reported no procedure-related deaths and no emergency bypass surgeries, with a 3-year all-cause mortality of 41.4% (reflecting the high-risk nature of the patients) 9. Another registry of 200 patients with acute coronary syndromes treated with left main PCI without on-site backup showed an 87% procedural success rate and an 11% in-hospital cardiac mortality, but the authors noted that outcomes improved over time, suggesting that with experience, such procedures can be performed safely 10.

It is important to note that the meta-analysis included a mix of patient types, and the results may not apply to every individual situation 5. However, the overall evidence is consistent: the presence of on-site cardiac surgery does not appear to reduce short-term mortality after PCI. Other factors, such as the use of intravascular imaging (IVUS or OCT) to guide stent placement, have been shown to reduce major adverse cardiac events in older patients 6, and participation in cardiac rehabilitation after PCI significantly lowers all-cause mortality (RR 0.69) 4. These interventions may be more impactful than surgical backup for improving outcomes.

What to ask your doctor

  • What is the 30-day mortality rate for stent procedures at this hospital, and how does it compare to national benchmarks?
  • Does this hospital have protocols in place to handle rare complications, such as emergency transfer to a surgical center if needed?
  • Would I benefit from intravascular imaging (IVUS or OCT) during my stent procedure to improve outcomes?
  • Can you refer me to a cardiac rehabilitation program after my stent procedure to help reduce my long-term risk?
  • Are there any specific risk factors in my case that might make on-site surgical backup more important?

This question is drawn from common patient questions about Pulmonology & Critical Care and answered using cited medical research. We do not provide individualized advice.