Are cardiac interventions without onsite surgery worth the risk?

There is a considerable decline in the use of CABG for failed PCI and the pressure to perform cardiac interventions in centres without onsite surgery is high. But is it necessary to increase the number of PCI centres in a densely populated country as the Netherlands? Advocates for expansion suggest a better patient outcome, but the evidence is not very solid. Arguments such as transport time are probably quite valid in large countries, but do not pertain to the Netherlands. Increasing the number of PCI centres will inevitably lead to fewer procedures per centre, per cardiologist and more complications and higher mortality. Waiting lists are no longer a relevant issue. Other less altruistic reasons might be the driving force. Percutaneous coronary intervention (PCI) is considered a commercially attractive intervention by cardiologists and institutions and seems to be the main motive for extension of the number of PCI centres.