The need for emergency cardiac bypass surgery due to a complication occurring during a PCI procedure has gone down from an initial 6–10 % in the early 1980s to less than 0.5 % in the present era [1]. Technological advances have made the procedure very safe in the hands of experienced operators working in dedicated centres. In Europe in the last decade, many PCI programs without surgery on-site have been started as a consequence of this rare need for actual surgical back-up. In addition, these PCI programs were started in (mostly rural) regions where travel distances to PCI centres with surgery on-site resulted in long delays for STEMI patients undergoing primary PCI. The safety and long-term efficacy outcome of PCI programs in centres without surgery on-site have been shown in registries and large randomised studies. Just recently, the MASS COMM investigators demonstrated in a large randomised trial including 3691 patients that there was no difference in the incidence of MACE at 30 days (9.5 % vs 9.4 %; RR 1.00; P < 0.001 for non-inferiority) and at 12 months (17.3 % vs 17.8 %; RR 0.98; P < 0.001 for non-inferiority) [2]. These data confirm and extend the results from the CPORT study published in 2012, which randomised 18,867 patients and showed no difference in 6-week mortality and no difference in MACE at 9 months (12.1 % vs 11.2 %; P = 0.05) [3]. Both these studies excluded patients undergoing urgent PCI procedures for STEMI and NSTEMI. Reports using non-randomised data from the NRMI database by Pride et al., which included 58,821 STEMI patients and more than 100,000 NSTEMI patients treated either in centres with or without surgery on-site confirmed that the safety (e.g., as assessed on the basis of short-term mortality and need for emergency surgery) and efficacy (e.g., procedural success and longer-term rate of survival) of such PCI procedures was similar [4, 5]. Following these developments, the Dutch Guidelines for Interventional Cardiology 2004 included recommendations for centres and operators that provide PCI without surgery on-site regarding facilities, staffing, training requirements etc [6]. The minimum number of procedures per centre and per operator are required in order to ensure proficiency, experience and continued quality of care. Moreover, structural relations with a surgical centre and protocols for emergency transfer should be present. In order to provide primary PCI for patients with STEMI, a 24–7 service is required and finally, centres are obliged to prospectively register procedures and outcomes and submit these data to the Dutch Society of Cardiology. In this issue of the Netherlands Heart Journal, the experience of the first year of PCI procedures of the Venlo Percutaneous Coronary Intervention Program at VieCurie Medical Centre Venlo and the six-month clinical outcome is reported by Mol et al [7]. A total of 333 patients were included and, as expected, the incidence of procedural complications and MACE at 6 months was low, 5.7 % and 13.1 % respectively. The results at 30 days were comparable to the earlier report by Mol et al [7] from the Medical Center Alkmaar. The authors are to be commended that they report their results, illustrating efficacy and safety of a PCI program without surgery on-site. Together with the data from the literature, we can conclude that PCI without surgery on-site is safe for selected patients when performed in experienced hands in dedicated centres. It is convenient for patients to be treated in a hospital nearby, and for ACS patients it is probably cost-saving as it avoids ambulance transfers. Several questions regarding the future quality of care in PCI programs remain: