Current PCI guidelines from the American Heart Association, American College of Cardiology, and Society for Cardiovascular Angiography and Interventions, published in 2006, said that performing elective PCI at centers with off-site surgical backup is "not recommended" (a class III category), and that primary PCI at these locations "may be considered" (a class IIb category) (J. Am. Coll. Cardiol. 2006;47:216-35). Favorable outcomes for primary PCI performed in facilities without cardiac surgery backup on site have been reported The new findings reported by Dr. Kutcher warrant upgrading both of these recommendations and designating both uses of PCI at centers with off-site backup as class IIa recommendations. Dr. Michael A. Kutcher performed a study using data collected by the NCDR CathPCI registry on consecutive cases done during Jan. 1, 2004, through March 30, 2006, with 308,161 patients treated at 465 U.S. centers. This included 9,029 patients treated with off-site surgical backup at 61 centers, and 299,132 patients treated at 404 centers with on-site surgical backup.