The safety of PCI without on-site cardiac surgery has been an ongoing debate since the early 1980’s. However, success rate has improved and acute reocclusion rate reduced since the introduction of stents and new antiplatelet therapy in the 1990s. PCI is now the predominant revascularization modality for coronary disease(CAD) worldwide and where available, primary PCI has become the standard of care for STEMI. In Ontario, 5 new standalone PCI centres have been established in the past 14 years. However, elective standalone PCI remained a Class IIb indication in the 2011 ACCF/AHA/SCAI guidelines. Nonetheless, the recent C-PORT and MASS COM trials in the US concluded that in non-emergency patients, standalone PCI is non-inferior to that performed in centres with on-site cardiac surgery. The Royal Alexandra Hospital performed the first standalone PCI in Canada in 1981 and has provided PCI services to a full spectrum of CAD patients ranging from elective, in-hospital to emergency cases with STEMI and cardiogenic shock. Surgical backup is located at the University of Alberta Hospital 6 km away. Joint case conference is conducted weekly with the cardiac surgery program. In the first 30 years, 23,261 PCIs were performed. We report our 30-year standalone experience, which we believe is the largest single centre experience in literature to date. PCI volumes, clinical and procedural characteristics, lesion success, emergency coronary bypass and mortality rates were collected and reported for the 30-year period. Results for 2006-2011, a period most relevant to current practice were compared with the most recent US PCI data. PCI volumes, CCS Class 4 patients, ad hoc, rescue and primary PCIs all increased significantly over the 30-year period. Success and emergency coronary bypass rates also improved (see Table). For 2006-11, our success, emergency CABG and 30-day mortality rates (96.5, 0.04, 1.1%) compared favorably with National Cardiovascular Data Registry (93-94, 0.3-0.4, 1.2-1.7 %*), C-PORT (93.4-94.1, 0.2, 0.8-0.9 %**) & MASS COM(95.6-97.1, 0.1-0.3, 0.3-0.7 %). PCIs can be performed safely in an experienced, high volume standalone centre with excellent success and very low complication rates. These results support the safety of establishing new standalone PCI centres to meet the growing population demand for percutaneous revascularization for coronary disease.