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Brandt MC, Alber H, Berger R, Binder RK, Mascherbauer J, Niessner A, Schmid M, Wernly B, Frick M. Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis. Wien Klin Wochenschr 2024; 136:44-60. [PMID: 38743083 PMCID: PMC11093862 DOI: 10.1007/s00508-024-02347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review should focus on trials with radial access, representing the current standard for coronary procedures in Austria and other European countries. METHODS The aim of this consensus statement is to review the most recent evidence for the safety and feasibility of performing same-day discharge procedures in selected patients. A structured literature search was performed using prespecified search criteria, focusing on trials with radial access procedures. RESULTS A total of 44 clinical trials and 4 large meta-analyses were retrieved, spanning 21 years of clinical evidence from 2001 to 2022. The outcome data from a wide range of clinical settings were unanimous in showing no negative effect on early (24 h) or late (30 day) major adverse events after same-day discharge coronary procedures. Based on nine prospective trials a comprehensive meta-analysis was compiled. Using 1‑month major adverse events data the pooled odds ratio of same-day discharge versus overnight stay procedures was 0.66 (95% confidence interval, CI 0.35-01.24; p = 0.19; I2 0%), indicating a noninferiority in carefully selected patients. CONCLUSION Outcome data from same-day discharge coronary intervention trials with radial access confirm the robust safety profile showing no increase in the risk of major adverse events compared to overnight stay.
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Affiliation(s)
- Mathias C Brandt
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Alber
- Department of Cardiology, Public Hospital Klagenfurt am Woerthersee, Klagenfurt am Woerthersee, Austria
| | - Rudolf Berger
- Department of Internal Medicine, Brothers of Saint John of God Eisenstadt, Eisenstadt, Austria
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Martin Schmid
- Department of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Matthias Frick
- Department of Internal Medicine I and Cardiology, Teaching Hospital Feldkirch, Feldkirch, Austria
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Taxiarchi P, Kontopantelis E, Kinnaird T, Curzen N, Banning A, Ludman P, Shoaib A, Rashid M, Martin GP, Mamas MA. Adoption of same day discharge following elective left main stem percutaneous coronary intervention. Int J Cardiol 2020; 321:38-47. [PMID: 32739446 PMCID: PMC7392050 DOI: 10.1016/j.ijcard.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. METHODS We analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. RESULTS SDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30-1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17-1.41) and those requiring ON stay (OR 0.58 95%CI 0.25-1.34). CONCLUSIONS We did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.
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Affiliation(s)
- Paraskevi Taxiarchi
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, UK
| | | | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Glen P Martin
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
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3
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Alkhawam H, Windish S, Abo-Salem E. Distal radial artery access among cases with radial artery occlusion for primary percutaneous intervention. Future Cardiol 2019; 15:169-173. [PMID: 31148471 DOI: 10.2217/fca-2018-0057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Radial artery access is associated with lower bleeding risks and higher patient satisfactions compared with femoral access. It is currently the preferred access for coronary catheterization and interventions, and increasingly used for peripheral and cranial vascular interventions. Herein, we present a patient who had a recent procedures included right transradial right vertebral artery and peripheral vascular interventions. She was admitted for abdominal aortic bifemoral artery bypass, and was complicated with ST elevation myocardial infarction that required immediate cardiac catheterization. Patient did not have palpable radial access and ultrasonography confirmed a total occlusion of right radial artery with thrombus. Although distal right radial artery - at the anatomical snuff box - was not palpable, artery was patent and could be accessed successfully with ultrasonography guidance.
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Affiliation(s)
- Hassan Alkhawam
- Center for Comprehensive Cardiovascular care, St Louis University, St Louis, MO 63110, USA
| | - Stephanie Windish
- Center for Comprehensive Cardiovascular care, St Louis University, St Louis, MO 63110, USA
| | - Elsayed Abo-Salem
- Center for Comprehensive Cardiovascular care, St Louis University, St Louis, MO 63110, USA
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Sgueglia GA, Gioffrè G, De Santis A, Piccioni F, Summaria F, Di Giorgio A, D'Errico F, Gaspardone A. Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions. Catheter Cardiovasc Interv 2019; 93:390-397. [PMID: 30298559 DOI: 10.1002/ccd.27844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/30/2018] [Accepted: 07/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of transradial 5 French percutaneous treatment of coronary bifurcations using conventional devices. BACKGROUND Radial artery is smaller than femoral artery, and its size may potentially limit transradial intervention, especially when coronary anatomy is not known. METHODS Patients with bifurcations lesions undergoing transradial 5 French ad hoc revascularization were treated according to provisional side branch (SB) stenting followed by the POT-SB dilation-final POT sequence. Only conventional devices were used. RESULTS Overall, 80 patients (58 men, 65 ± 10 years) were enrolled. True bifurcations accounted for 64% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (n = 37, 46%) and left main coronary artery bifurcation being treated in 6 (8%) patients. Angiographic success was achieved in 78 (97.5%) patients through a 5 French guiding catheter whereas in two cases, a 5-6 French guiding catheter upgrade was required to optimize SB treatment after the main bifurcation vessel have been secured. Overall, procedural success was achieved in all but one patient who had periprocedural necrosis following multivessel PCI. Another patient underwent target bifurcation revascularization because of a critical restenosis in a significant SB yielding an acute coronary syndrome five months after the index procedure. CONCLUSIONS This study demonstrates the feasibility of transradial 5 French bifurcation intervention with nondedicated devices and preliminary supports its efficacy and safety over a wide range of bifurcation anatomy and complexity.
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Affiliation(s)
| | | | | | | | | | - Angela Di Giorgio
- Servizio di Angiologia - Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
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Córdoba-Soriano JG, Rivera-Juárez A, Gutiérrez-Díez A, Gutiérrez-Ibañes E, Gallardo-López A, Samaniego-Lampón B, Lozano I, Melehi D, Portero-Portaz JJ, Elízaga J, Jiménez-Mazuecos J. The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:875-882. [PMID: 30639420 DOI: 10.1016/j.carrev.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.
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Affiliation(s)
| | | | | | | | | | | | - Iñigo Lozano
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Driss Melehi
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Jaime Elízaga
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Identifying a better strategy for ad hoc percutaneous coronary intervention in patients with anticipated unfavorable radial access: the Little Women study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:413-417. [DOI: 10.1016/j.carrev.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD). RECENT FINDINGS This literature review was performed to evaluate the studies that were published over the last 17 years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: "same day," "same day discharge," "outpatient," and "ambulatory radial PCI." Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals. The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.
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Affiliation(s)
- Ali Elfandi
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, 07960, USA
| | - Jordan G Safirstein
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, 07960, USA.
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Aminian A, Saito S, Takahashi A, Bernat I, Jobe RL, Kajiya T, Gilchrist IC, Louvard Y, Kiemeneij F, Van Royen N, Yamazaki S, Matsukage T, Rao SV. Comparison of a new slender 6 Fr sheath with a standard 5 Fr sheath for transradial coronary angiography and intervention: RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT), a randomised multicentre trial. EUROINTERVENTION 2017; 13:e549-e556. [PMID: 28218605 DOI: 10.4244/eij-d-16-00816] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The 6 Fr Glidesheath Slender (GSS6Fr) is a recently developed thin-walled radial sheath with an outer diameter (OD) that is smaller than the OD of standard 6 Fr sheaths. The purpose of this trial was to clarify whether the use of this new slender sheath would result in similar rates of RAO to a standard 5 Fr sheath in unselected patients undergoing transradial (TR) coronary angiography and/or intervention, and to assess the relative importance of sheath size and haemostasis protocol on the rate of RAO. METHODS AND RESULTS We conducted a randomised, multicentre, non-inferiority trial comparing the GSS6Fr against the standard GS5Fr in patients undergoing TR coronary angiography and/or intervention. Patients in each group were subsequently randomised to undergo patent haemostasis or the institutional haemostasis protocol. The primary endpoint was the occurrence of RAO at discharge. A total of 1,926 patients were randomised in 12 centres. The incidence of RAO was 3.47% with GSS6Fr compared with 1.74% with GS5Fr (risk difference 1.73%, 95% CI: 0.51-2.95%; pnon-inferiority=0.150). Patients randomised to patent haemostasis had a similar rate of RAO compared with institutional haemostasis (2.61% vs. 2.61%, p=1). There was no difference with regard to all secondary endpoints, including vascular access-site complications, local bleeding and spasm. CONCLUSIONS In this large multicentre randomised trial, the GSS6Fr was associated with a low event rate for the primary endpoint (RAO), although non-inferiority to the GS5Fr was not met, due to a lower than expected rate of RAO in the GS5Fr group. As compared to institutional haemostasis, the use of patent haemostasis was not associated with a reduced rate of RAO.
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Affiliation(s)
- Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
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9
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Graziano FD, Banga S, Busman DK, Muthusamy P, Wohns DH. Barriers to Early Discharge after Elective Percutaneous Coronary Intervention (BED PCI): A Single-Center Study. Indian Heart J 2016; 69:217-222. [PMID: 28460770 PMCID: PMC5414966 DOI: 10.1016/j.ihj.2016.11.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/23/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To identify patient characteristics and procedural factors that may play a role in hindering same-day discharge (SDD) practices. Background Multiple studies have shown the safety and cost effectiveness of SDD following elective percutaneous coronary intervention (PCI), but factors that hinder SDD practices have not been thoroughly studied. Material and Methods A retrospective comparative analysis of elective PCI patients who had an overnight stay (OS) (n = 345) vs. SDD patients (n = 222) was conducted to identify significant differences between the two groups in baseline patient characteristics, procedural, and postprocedural factors. Results Comparing OS to SDD patients, OS patients had a lower prevalence of radial access (20.29% vs. 39.64%, P < 0.0001); a higher incidence of suboptimal angiographic results (14.49% vs. 1.80%, P = 0.0027); CRCL values lower than 60 mL/min (26.38% vs. 15.32%, P = 0.0019); and greater femoral vascular site hemostasis with manual compression (69.09% vs. 36.57%, P = 0.0027). OS patients received larger sheath sizes (P = 0.0209), more bivalirudin (45.80% vs. 36.70%) and glycoprotein IIb/IIIa inhibitors (5.51% vs. 2.25%), but less heparin (51.30% vs. 53.21%). Chest pain (8.12% vs. 0.92%, P = 0.0042) and vascular access site concerns (20.58% vs. 0%, P = 0.0027) were more common among OS patients. Conclusions Pre-, peri-, and post-procedural factors play a role in SDD eligibility. Understanding factors that limit as well as those that facilitate SDD may enable institutions to establish or enhance a SDD program.
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Affiliation(s)
| | - Sandeep Banga
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
| | - Denise K Busman
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
| | | | - David H Wohns
- Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA; Spectrum Health, Grand Rapids, MI, USA
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Spiliopoulos S, Karnabatidis D, Katsanos K, Diamantopoulos A, Ali T, Kitrou P, Cannavale A, Krokidis M. Day-Case Treatment of Peripheral Arterial Disease: Results from a Multi-Center European Study. Cardiovasc Intervent Radiol 2016; 39:1684-1691. [PMID: 27481496 DOI: 10.1007/s00270-016-1436-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/26/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of the study was to investigate safety and feasibility of day-case endovascular procedures for the management of peripheral arterial disease. MATERIALS AND METHODS This was a multi-center, retrospective study including all patients treated over a 30-month period with endovascular angioplasty or stenting for intermittent claudication (IC) or critical limb ischemia (CLI) on a day-case basis, in Interventional Radiology (IR) departments of three European tertiary hospitals. Exclusion criteria were not related to the type of lesion and included unavailability of an adult able to take care of patient overnight; high bleeding risk and ASA score ≥4. Primary efficacy outcome was the rate of procedures performed on an outpatient basis requiring no further hospitalization and primary safety outcome was freedom from 30-day major complications' rate. RESULTS The study included 652 patients (male 75 %; mean age 68 ± 10 years; range: 27-93), 24.6 % treated for CLI. In 53.3 % of the cases a 6Fr sheath was used. Technical success was 97.1 %. Haemostasis was obtained by manual compression in 52.4 % of the accesses. The primary efficacy outcome occurred in 95.4 % (622/652 patients) and primary safety outcome in 98.6 % (643/652 patients). Major complications included five (0.7 %) retroperitoneal hematomas requiring transfusion; one (0.1 %) common femoral artery pseudoaneurysm successfully treated with US-guided thrombin injection, two cases of intra-procedural distal embolization treated with catheter-directed local thrombolysis and one on-table cardiac arrest necessitating >24 h recovery. No major complication was noted after same-day discharge. CONCLUSIONS Day-case endovascular procedures for the treatment of IC or CLI can be safely and efficiently performed in experienced IR departments of large tertiary hospitals.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, Patras, Greece.
- 2nd Radiology Department, Division of Interventional Radiology, Attikon University General Hospital, 1st Rimini St, Chaidari, 12461, Athens, Greece.
| | | | - Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK
| | - Tariq Ali
- Department of Interventional Radiology, Addenbrooke's University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Panagiotis Kitrou
- Department of Interventional Radiology, Patras University Hospital, Patras, Greece
| | - Alessandro Cannavale
- Department of Interventional Radiology, Addenbrooke's University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Miltiadis Krokidis
- Department of Interventional Radiology, Addenbrooke's University Hospital, NHS Foundation Trust, Cambridge, UK
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RAJANI NIKILK, BROWN ADAMJ, MCCORMICK LIAMM, PARWAIZ HAMMAD, KAUSHAL ANMOL, HOOLE STEPHENP, WEST NICKEJ. Institutional Switch from Transfemoral to Transradial Vascular Access for Percutaneous Coronary Intervention was Associated with a Reduction in Bleeding Events: A Singlecenter Experience of >10,000 Consecutive Cases. J Interv Cardiol 2015; 28:296-304. [DOI: 10.1111/joic.12205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- NIKIL K. RAJANI
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - ADAM J. BROWN
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - LIAM M. MCCORMICK
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - HAMMAD PARWAIZ
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - ANMOL KAUSHAL
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - STEPHEN P. HOOLE
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
| | - NICK E. J. WEST
- Department of Interventional Cardiology; Papworth Hospital NHS Foundation Trust; Cambridge United Kingdom
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Gray B, Klimis H, Inam S, Ariyathna N, Kumar S, Bailey B, Patel S. Radiation Exposure During Cardiac Catheterisation is Similar for Both Femoral and Radial Approaches. Heart Lung Circ 2015; 24:264-9. [DOI: 10.1016/j.hlc.2014.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
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Stajic Z, Romanovic R, Tavciovski D. Forearm approach for percutaneous coronary procedures. Acta Inform Med 2014; 21:283-7. [PMID: 24554806 PMCID: PMC3916167 DOI: 10.5455/aim.2013.21.283-287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/02/2013] [Indexed: 12/29/2022] Open
Abstract
This article gives contemporary review on the forearm approach for percutaneous diagnostic and interventional coronary procedures. Advantages and disadvantages as well as practical issues and current controversies regarding both radial and ulnar artery approach are discussed throughout the paper. Having in mind advantages of forearm approach in terms of safety and comfort over the traditional femoral approach, as well as the rapid development of invasive technology in the past years, it will probably become the default vascular approach for all percutaneous coronary procedures in the near future.
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Affiliation(s)
- Zoran Stajic
- Clinic of Cardiology, Military Academy, Belgrade, Serbia
| | - Radoslav Romanovic
- Clinic of Emergency Internal Medicine, Military Academy, Belgrade, Serbia
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Aminian A, Dolatabadi D, Lefebvre P, Zimmerman R, Brunner P, Michalakis G, Lalmand J. Initial experience with the glidesheath slender for transradial coronary angiography and intervention: A feasibility study with prospective radial ultrasound follow-up. Catheter Cardiovasc Interv 2013; 84:436-42. [DOI: 10.1002/ccd.25232] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/26/2013] [Accepted: 09/24/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Adel Aminian
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Dariouch Dolatabadi
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Pascal Lefebvre
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Robert Zimmerman
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Philippe Brunner
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Georges Michalakis
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
| | - Jacques Lalmand
- Division of Cardiology; Centre Hospitalier Universitaire de Charleroi; Charleroi Belgium
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15
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Access site complications and puncture site pain following transradial coronary procedures: A correlational study. Int J Nurs Stud 2013; 50:1304-13. [DOI: 10.1016/j.ijnurstu.2012.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 11/24/2012] [Accepted: 12/25/2012] [Indexed: 11/18/2022]
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Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ. Same-Day Discharge After Percutaneous Coronary Intervention. J Am Coll Cardiol 2013; 62:275-85. [DOI: 10.1016/j.jacc.2013.03.051] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/27/2013] [Accepted: 03/13/2013] [Indexed: 12/29/2022]
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Brewster S, Khimdas K, Cleary N, Penswick A, Cliffe S, Weerackody R, Wragg A, Rothman MT, Archbold RA. Impact of a dedicated "radial lounge" for percutaneous coronary procedures on same-day discharge rates and bed utilization. Am Heart J 2013; 165:299-302. [PMID: 23453096 DOI: 10.1016/j.ahj.2012.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/03/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Two advantages of transradial coronary procedures are an increased potential for same-day discharge and better resource management. This study assessed the impact of a dedicated "radial lounge" (1) on the rate of same-day discharge after elective percutaneous coronary intervention (PCI) and coronary angiography and (2) on bed utilization. METHODS We compared our unit's rates of same-day discharge in patients who underwent elective PCI or coronary angiography in the year before and in the year after the opening of a dedicated radial lounge for elective patients. RESULTS In its first year of operation, 439 patients who underwent PCI and 1,109 patients who underwent angiography were managed in the radial lounge. Among these patients, the rate of same-day discharge was 84.7% after PCI and 97.0% after angiography. Requirement for overnight admission was significantly more common after femoral access compared with radial access for both angiography (4.1% vs 2.8%, P < .05) and PCI (20.3% vs 14.2%, P < .01). The unit's overall rate of same-day discharge increased from 2.3% to 51.2% after elective PCI (P < .0005) and from 72.7% to 84.9% after elective angiography (P < .005). An estimated 595 bed days were saved through reduced overnight admissions in elective patients. CONCLUSIONS Our unit's overall rates of same-day discharge after elective PCI and coronary angiography increased dramatically in the year after the opening of a dedicated radial lounge. This was directly attributable to the high rates of same-day discharge in radial lounge patients. The radial lounge impacted favorably on in-patient bed capacity.
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Abdelaal E, Rao SV, Gilchrist IC, Bernat I, Shroff A, Caputo R, Costerousse O, Pancholy SB, Bertrand OF. Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2013; 6:99-112. [DOI: 10.1016/j.jcin.2012.10.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/26/2012] [Accepted: 10/26/2012] [Indexed: 12/29/2022]
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Lo TS, Ratib K, Chong AY, Bhatia G, Gunning M, Nolan J. Impact of access site selection and operator expertise on radiation exposure; a controlled prospective study. Am Heart J 2012; 164:455-61. [PMID: 23067901 DOI: 10.1016/j.ahj.2012.06.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Published data relating to arterial access site selection and radiation exposure during coronary procedures suggest radial access may lead to increased radiation exposure, but this is based on poorly controlled studies. We sought to measure radiation exposure to patients and operators during elective coronary angiography (CA) according to access site, with other procedure related variables controlled for. We also investigated the specific effect of operator expertise in relation to radiation exposure. METHODS 100 consecutive patients undergoing first time elective CA were recruited prospectively. An expert transradial (TR) and an expert transfemoral (TF) operator performed 25 cases each via their default route. A trainee cardiologist with intermediate experience in both access sites performed 25 cases via each route. Angiographic projections were standardised and optimised radiation protection was utilised for all procedures. The primary endpoints were operator and patient exposure, quantified by effective dose (ED) and dose area product (DAP) respectively. Secondary endpoints included fluoroscopy time (FT) and time to patient ambulation. RESULTS The trainee operator recorded higher values for radiation exposure in radial and femoral cases when compared to the expert operators. There were no significant differences in radiation exposure during CA to operator or patient according to access site when standardised by operator experience. For the trainee, ED for TR and TF procedures was 8.8 ± 4.3 μSv and 8.5 ± 6.5 μSv (P = .86) and DAP was 25.4 ± 4.8 Gycm(2) vs 25.2 ± 8.3 Gycm(2) (P = .9). For the expert TR and TF operators, ED was 6.4 ± 4.7 μSv vs 6.1 ± 5.6 μSv (P = .85) and DAP was 21.7 ± 6.5 Gycm(2) vs 22.4 ± 8.0 Gycm(2), (P = .74). There was no significant difference in FT in relation to access site. Time to ambulation was significantly longer with TF access. CONCLUSION The use of TR access has no adverse effect on radiation exposure or FT for diagnostic CA, but does allow for quicker ambulation compared to TF access. The magnitude of radiation exposure is related to operator expertise for both access sites. The results of previous studies reflect the effect of uncontrolled patient and operator variables and not access site selection.
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Muthusamy P, Busman DK, Davis AT, Wohns DH. Assessment of clinical outcomes related to early discharge after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 81:6-13. [DOI: 10.1002/ccd.24537] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 06/24/2012] [Indexed: 12/29/2022]
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Ball WT, Sharieff W, Jolly SS, Hong T, Kutryk MJB, Graham JJ, Fam NP, Chisholm RJ, Cheema AN. Characterization of operator learning curve for transradial coronary interventions. Circ Cardiovasc Interv 2011; 4:336-41. [PMID: 21813402 DOI: 10.1161/circinterventions.110.960864] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transradial percutaneous coronary intervention (TR-PCI) improves clinical outcomes compared to the transfemoral (TF) approach. However, inadequate training and experience has limited widespread adoption by interventional cardiologists. METHODS AND RESULTS Clinical and procedural characteristics for TR-PCI were prospectively collected from 1999 to 2008. To identify minimum case volume for optimum clinical benefit, single-vessel TR-PCI cases were chronologically ranked and stratified into 1 to 50, 51 to 100, 101 to 150 and 151 to 300 case volume groups for operators starting the TR approach at the study institution. Cases by operators with a >300 TR-PCI case volume comprised the control group. TR-PCI failure rates, contrast use, guide usage, and fluoroscopy time were compared among groups. A total of 1672 patients underwent TR-PCI by 28 operators. TR-PCI failure occurred in 4% and was higher in the 1 to 50 case volume group compared to the 51 to 100 (P=0.007) and control (P=0.01) groups. Contrast use was greater in the 1 to 50 group (180±79 mL) compared to the 151 to 300 (157±75 mL, P=0.02) and control (168±79 mL, P=0.05) groups. Fluoroscopy time was higher in the 1 to 50 group (15±10 minutes) compared to the 101 to 150 (13±10 minutes, P=0.04) and control (12±9 minutes, P=0.02) groups. Reasons for TR-PCI failure included spasm (38%), subclavian tortuousity (16%), poor guide support (16%), failed access (10%), and radial loop (7%). Case volume was significantly correlated with TR-PCI failure (β=-0.0076, P=0.0028), and odds of failure was reduced by 32% for each 50 increments in case volume. CONCLUSIONS TR-PCI success depends on operator experience, and a case volume of ≥50 cases is required to achieve outcomes comparable to experienced operators. These findings have implications both for PCI operators looking to expand their skills and for defining standards for training.
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Affiliation(s)
- Warren T Ball
- Terrence Donnelly Heart Center, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada
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Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, Frasier D, Gulati R, Skelding K, Bertrand O, Patel T. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78:823-39. [PMID: 21544927 DOI: 10.1002/ccd.23052] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/13/2011] [Indexed: 01/21/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/standards
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/methods
- Cardiac Catheterization/standards
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/therapy
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/methods
- Catheterization, Peripheral/standards
- Clinical Competence
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/standards
- Credentialing
- Endovascular Procedures/adverse effects
- Endovascular Procedures/methods
- Endovascular Procedures/standards
- Humans
- Patient Selection
- Radial Artery
- Risk Assessment
- Risk Factors
- Societies, Medical
- Treatment Outcome
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Affiliation(s)
- Ronald P Caputo
- St. Joseph's Hospital, S.U.N.Y. Upstate Medical School, Syracuse, New York 13203, USA.
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Chung WJ, Fang HY, Tsai TH, Yang CH, Chen CJ, Chen SM, Cheng CI, Fang CY, Hsieh YK, Hang CL, Yip HK, Wu CJ. Transradial approach percutaneous coronary interventions in an out-patient clinic. Int Heart J 2011; 51:371-6. [PMID: 21173510 DOI: 10.1536/ihj.51.371] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Same-day discharge transradial percutaneous coronary intervention (TRI) has been reported to be safe and feasible in Western countries. However, Asia has not produced any reports related to this matter. The present study explored the safety and feasibility of patients with indications for TR coronary angiography and ad hoc PCI with a same-day discharge protocol. Between October 1995 and December 2002, 660 adult patients were admitted to our hospital for ad hoc PCIs. Of these, 214 patients were discharged on the day of their PCI (group A), while the remaining 446 patients were referred for out-patient department (OPD) PCI with subsequent admission (group B). Periprocedural complications were not significantly different between the groups. There were no differences in 1-month major adverse cardiac events including death, myocardial infarction, and target vessel revascularization (1.4% versus 0.2% for groups A and B, respectively; P = 0.068). Three group A cases (1.4%) experienced peri- and post-PCI myocardial infarction and one group B case (0.2%) experienced a post-PCI myocardial infarction. No patient died or required emergency bypass surgery. In group A, 8 cases (3.7%) required cutting balloon angioplasty and 2 cases (0.9%) needed rotational atherectomy. TRI is safe and feasible on an outpatient basis. For select patients, even though PCI can carry the potential risk of subsequent cutting balloon angioplasty or rotational atherectomy, the procedure should still be considered.
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Affiliation(s)
- Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine
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Patel M, Kim M, Karajgikar R, Kodali V, Kaplish D, Lee P, Moreno P, Krishnan P, Sharma SK, Kini AS. Outcomes of patients discharged the same day following percutaneous coronary intervention. JACC Cardiovasc Interv 2010; 3:851-8. [PMID: 20723858 DOI: 10.1016/j.jcin.2010.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/29/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the outcomes of patients discharged the day of percutaneous coronary intervention (PCI) by analyzing the data from a single-center, large, multioperator registry of interventions. BACKGROUND Although same-day discharge is likely safe after interventions on low-risk stable patients, there is limited data to guide selection of a broader population of patients. Due to numerous patient variables and physician preferences, standardization of the length of stay after PCI has been a challenge. Most of the reported studies on same-day discharge have strict inclusion criteria and hence do not truly reflect a real-world population. METHODS We analyzed the outcomes of consecutive same-day discharge in 2,400 of 16,585 patients who underwent elective PCI without any procedural or hospital complication. Composite end point included 30-day major adverse cardiac cerebral events and bleeding/vascular complications. RESULTS The mean age of the study population was 57.0 +/- 23.7 years with 12% aged over 65 years. Twenty-eight percent received glycoprotein IIb/IIIa inhibitor with closure devices in 90.5%. Clinical and angiographic success was noted in 97% of all PCIs. The average length-of-stay following PCI was 8.2 +/- 2.5 h. The composite end point was reached in 23 patients (0.96%). Major adverse cardiac cerebral events occurred in 8 patients (0.33%) and vascular/bleeding complications in the form of Thrombolysis In Myocardial Infarction minor bleeding in 14 patients (0.58%) and pseudoaneurysm in 1 patient (0.04%). CONCLUSIONS When appropriately selected, with strict adherence to the set protocol, same-day discharge after uncomplicated elective PCI is safe despite using femoral access in a wide spectrum of patients.
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Affiliation(s)
- Mehul Patel
- Cardiac Catheterization Laboratory of the Zena and Michael A Weiner Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6754, USA
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Scott IA. Public hospital bed crisis: too few or too misused? AUST HEALTH REV 2010; 34:317-24. [PMID: 20797364 DOI: 10.1071/ah09821] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 11/26/2009] [Indexed: 12/23/2022]
Abstract
* Increasing demand on public hospital beds has led to what many see as a hospital bed crisis requiring substantial increases in bed numbers. By 2050, if current bed use trends persist and as the numbers of frail older patients rise exponentially, a 62% increase in hospital beds will be required to meet expected demand, at a cost almost equal to the entire current Australian healthcare budget. * This article provides an overview of the effectiveness of different strategies for reducing hospital demand that may be viewed as primarily (although not exclusively) targeting the hospital sector - increasing capacity and throughput and reducing readmissions - or the non-hospital sector - facilitating early discharge or reducing presentations and admissions to hospital. Evidence of effectiveness was retrieved from a literature search of randomised trials and observational studies using broad search terms. * The principal findings were as follows: (1) within the hospital sector, throughput could be substantially improved by outsourcing public hospital clinical services to the private sector, undertaking whole-of-hospital reform of care processes and patient flow that address both access and exit block, separating acute from elective beds and services, increasing rates of day-only or short stay admissions, and curtailing ineffective or marginally effective clinical interventions; (2) in regards to the non-hospital sector, potentially the biggest gains in reducing hospital demand will come from improved access to residential care, rehabilitation services, and domiciliary support as patients awaiting such services currently account for 70% of acute hospital bed-days. More widespread use of acute care and advance care planning within residential care facilities and population-based chronic disease management programs can also assist. * This overview concludes that, in reducing hospital bed demand, clinical process redesign within hospitals and capacity enhancement of non-hospital care services and chronic disease management programs are effective strategies that should be considered before investing heavily in creating additional hospital beds devoid of any critical reappraisal of current models of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, Ipswich Road, Brisbane, QLD 4102, Australia.
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Franchi E, Marino P, Biondi-Zoccai GG, De Luca G, Vassanelli C, Agostoni P. Transradial versus transfemoral approach for percutaneous coronary procedures. Curr Cardiol Rep 2010; 11:391-7. [PMID: 19709500 DOI: 10.1007/s11886-009-0054-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Selective coronary angiography was originally performed through open brachial arteriotomy. Thereafter, the percutaneous Seldinger technique and the use of preformed Judkins-type catheters popularized the femoral approach. More recently, after the first report of successful coronary angiography by the transradial approach in 1989, the radial artery has been increasingly used as an alternative access site. The main advantage offered by the transradial approach is represented by the very low (< 1%) incidence of relevant vascular access site complications, which on the contrary occur in about 3% to 7% of patients undergoing procedures through the femoral route. The main disadvantage is a higher incidence of procedural failure that leads to a crossover to the femoral route. In this review, we examine the available evidence on transradial and transfemoral approach advantages, disadvantages, and complications in coronary angiography and intervention. Their use in the acute myocardial infarction setting and other situations is described. Vascular closure device usefulness is also considered.
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Affiliation(s)
- Elena Franchi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventions. JACC Cardiovasc Interv 2009; 2:1057-64. [DOI: 10.1016/j.jcin.2009.07.014] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 06/19/2009] [Accepted: 07/09/2009] [Indexed: 11/20/2022]
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Chambers CE, Dehmer GJ, Cox DA, Harrington RA, Babb JD, Popma JJ, Turco MA, Weiner BH, Tommaso CL. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Endorsed by the American College of Cardiology Foundation. Catheter Cardiovasc Interv 2009; 73:847-58. [PMID: 19425053 DOI: 10.1002/ccd.22100] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Percutaneous coronary intervention (PCI) is the most common method of coronary revascularization. Over time, as operator skills and technical advances have improved procedural outcomes, the length of stay (LOS) has decreased. However, standardization in the definition of LOS following PCI has been challenging due to significant physician, procedural, and patient variables. Given the increased focus on both patient safety as well as the cost of medical care, system process issues are a concern and provide a driving force for standardization while simultaneously maintaining the quality of patient care. This document: (1) provides a summary of the existing published data on same-day patient discharge following PCI, (2) reviews studies that developed methods to predict risk following PCI, and (3) provides clarification of the terms used to define care settings following PCI. In addition, a decision matrix is proposed for the care of patients following PCI. It is intended to provide both the interventional cardiologist as well as the facilities, in which they are associated, a guide to allow for the appropriate LOS for the appropriate patient who could be considered for early discharge or outpatient intervention.
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Affiliation(s)
- Charles E Chambers
- Pennsylvania State University Hershey Medical Center, Hershey, Pennsylvania, USA
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Lombardo-Martínez J, Díaz-Bejarano D, Pedrosa-Carrera C, Sánchez-Baños B, Gómez-Santana C, Fernández Álvarez V, González-Díaz JM, González-Rivero D, Valero-López A, Cubero-Gómez JM. Ensayo clínico sobre la compresión radial guiada por la presión arterial media. ENFERMERIA CLINICA 2009; 19:199-205. [DOI: 10.1016/j.enfcli.2009.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 01/26/2009] [Indexed: 10/20/2022]
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Blankenship JC. Here today, gone today: Time for same-day discharge after PCI. Catheter Cardiovasc Interv 2008; 72:626-8. [DOI: 10.1002/ccd.21829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
INTRODUCTION AND AIM Post-percutaneous coronary intervention (PCI) length of hospital stay (LOHS) is one of the key modifiers of hospital cost and quality assessment. Commencing 2000, the cardiovascular services at our institution engaged in a continuous quality improvement program to reduce post-PCI LOHS. METHODS All PCI patients were screened for potential early discharge. An expedited discharge protocol was applied to all suitable patients. Length of hospital stay and other outcomes were monitored daily. Data were compiled and reported monthly and quarterly by an independent chart review and data analysis team. RESULTS Over the study period, PCI volume increased 4-fold. Annually, 61.8% to 78.4% of the patients were rendered suitable for abbreviated LOHS. Timely discharge of suitable candidates gradually improved from 77.6% (n = 116) discharged within 48 hours in 2000 to 95% (n = 480) discharged within 30 hours in 2006. CONCLUSION With the appropriate continuous quality improvement program, 30-hour post-PCI discharge is feasible in more than 95% of suitable cases.
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Small A, Klinke P, Della Siega A, Fretz E, Kinloch D, Mildenberger R, Williams M, Hilton D. Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study. Catheter Cardiovasc Interv 2008; 70:907-12. [PMID: 17621672 DOI: 10.1002/ccd.21277] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the timeframe of postprocedural complications following transradial percutaneous intervention in selected nonlow-risk risk patients as a feasibility study for same day discharge. BACKGROUND Percutaneous coronary intervention (PCI) is traditionally performed as an inpatient procedure. Transradial access with its lower complication rate facilitates safe and same day discharge. We hypothesize that with current standards of pharmacotherapy and intervention, complications post transradial percutaneous coronary angioplasty even in a nonlow-risk patient cohort will be evident within 6 hr or occur more than 24 hr post procedure. Under these circumstances, overnight stay results in no improvement in patient safety. METHODS 2,189 patients underwent transradial PCI at our institution between January 2005 and June 2006. Of these 1,174 were assessed as intermediate or high risk and admitted postprocedure. The remaining 1,015 were assessed as low risk and discharged the day of procedure. All 1,174 inpatients were entered into our study database. Information was collected on patient demographics, angiographic characteristics, post procedural complications, and timing of post procedural events. RESULTS 1,543 ACC type B2 or C lesions were treated in 1,174 patients. All post-procedural complications were identified within 6 hr of the intervention or occurred more than 24 hr later when patients would have been discharged according to overnight admission protocols. CONCLUSIONS Day case transradial percutaneous intervention with a 6-hr period of post procedure observation is a safe and feasible practice. The presence of higher-risk features should not be considered an absolute indication for overnight admission in patients considered clinically appropriate for discharge.
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Affiliation(s)
- Andrew Small
- Victoria Heart Institute Foundation, Victoria, British Columbia, Canada
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Ambulatory transradial angioplasty in Mexico: is it possible? Arch Med Res 2007; 39:147-8. [PMID: 18068011 DOI: 10.1016/j.arcmed.2007.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 07/16/2007] [Indexed: 11/21/2022]
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Bertrand OF, Larose E, De Larochellière R, Proulx G, Nguyen CM, Déry JP, Gleeton O, Barbeau G, Noël B, Rouleau J, Boudreault JR, Roy L, Rodés-Cabau J. Outpatient percutaneous coronary intervention: Ready for prime time? Can J Cardiol 2007; 23 Suppl B:58B-66B. [PMID: 17932589 PMCID: PMC2794470 DOI: 10.1016/s0828-282x(07)71012-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 06/17/2007] [Indexed: 11/21/2022] Open
Abstract
Outpatient practice after percutaneous coronary intervention (PCI) is gaining momentum due to constantly optimizing results. Furthermore, the availability of limited beds to handle the large volume of coronary interventions also promotes outpatient practice. The present report relates the current experience with same-day discharge and defines persisting challenges in promoting accelerated in-hospital turnover. Since the mid-1990s, there have been several reports on same-day discharge following uncomplicated procedures. Overall, the success of outpatient PCI practice is based on a few technological and pharmacological advances. First, the systematic use of stents and potent antiplatelet agents have revolutionized the acute success rates of PCI by virtually eliminating the risks of acute vessel closure within the first 24 h following a successful procedure. Second, the miniaturization of catheter sizes has also simplified access site management, accelerated ambulation time and limited the risks of puncture site bleeding. In this regard, the transradial approach initially described in Canada and later popularized in Europe has transformed the acute care of patients after PCI. Today, however, the practice of transradial PCI still varies largely from country to country. From the literature review, it appears that after a short period of observation (4 h to 6 h), the majority of eligible patients who have undergone uncomplicated coronary stenting can be discharged on the same day. Whereas implementation of same-day discharge to referring centres is simple, home discharge requires the development of structured outpatient programs with dedicated resources to assist the patient and family with short-term logistics, to provide reassurance, to serve as a 'safety net' and, lastly, to promote medication compliance and cardiovascular risk factor management. Further studies are required to better define the cost-minimization effects of outpatient PCI practice, as well as patient perception of fast-track PCI. It is proposed that outpatient PCI will likely continue to expand over the next decade.
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Affiliation(s)
| | - Eric Larose
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | | | - Guy Proulx
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | - Can Manh Nguyen
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | | | - Onil Gleeton
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | - Gérald Barbeau
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | - Bernard Noël
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | - Jacques Rouleau
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
| | | | - Louis Roy
- Interventional Cardiology Laboratories, Laval Hospital, Quebec
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