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Ettachfini T, Gibault-Genty G, Blicq E, Godeau G, Fofana CH, Lefèvre G, Ajlani B, Livarek B. [Outpatient coronary angiography and percutaneous coronary interventions before and after the COVID-19 pandemic : experience of the Versailles hospital centre]. Ann Cardiol Angeiol (Paris) 2024; 73:101809. [PMID: 39357419 DOI: 10.1016/j.ancard.2024.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI. MATERIALS AND METHODS We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or ad hoc), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4. RESULTS A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016-2017 to 620 (27.2%) in 2023-2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low. CONCLUSION Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.
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Affiliation(s)
- Taha Ettachfini
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc.
| | - Géraldine Gibault-Genty
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Elodie Blicq
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Guillaume Godeau
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Cheick-Hamala Fofana
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
| | - Grégoire Lefèvre
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France.
| | - Badreddine Ajlani
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France; Service de cardiologie, Centre Hospitalier de Rambouillet, Rambouillet, France.
| | - Bernard Livarek
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay-Rocquencourt, France.
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Chia J, Wilson A, Law D, Kelly M, Lambert B. The safety of same-day discharge following percutaneous coronary intervention in regional Australia. Intern Med J 2024. [PMID: 39324567 DOI: 10.1111/imj.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Same-day discharge (SDD) following percutaneous coronary intervention (PCI) has proven safe, and global adoption of this strategy has been increasing rapidly. These data are predominantly derived from high-volume, metropolitan centres with a relative paucity of data from regional and remote settings. AIMS The primary objective of this study was to evaluate the outcomes of a same-day, criteria-led discharge strategy following elective transradial PCI in a regional setting. METHODS This is a retrospective, single-centre cohort study. Consecutive outpatients aged ≥18 years presenting for elective transradial invasive coronary angiography between March 2019 and February 2024 were included in the analysis. We report the primary composite outcome of 30-day all-cause mortality and unplanned hospital readmission and compare proportions between those who were discharged on the day of their procedure with those admitted overnight in hospital and discharged the next day. RESULTS A total of 555 eligible patients were identified, of which 330 (60%) were discharged on the day of their procedure. The composite primary end-point occurred in seven (2%) of the SDD patients and in six (3%) of the overnight admission patients (relative risk = 0.80; 95% confidence interval = 0.27-2.34; P = 0.68). No significant differences were seen in rates of readmission, or in other clinical outcomes assessed, including death, myocardial infarction, stroke and vascular complications or bleeding. CONCLUSION In a regional setting, SDD following elective transradial PCI, in select patients, is a safe approach which was not associated with higher rates of unplanned readmission or adverse clinical outcomes.
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Affiliation(s)
- Justin Chia
- Department of Cardiology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Angus Wilson
- Department of Cardiology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - David Law
- Department of Cardiology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Maura Kelly
- Department of Cardiology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Benjamin Lambert
- Department of Cardiology, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
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Khan FR, Nawaz T, Amin M, Sajjad W, Ali H, Hussain S. The Impact of Age, Comorbidities, and Discharge Timing on Clinical Outcomes Following Elective Percutaneous Coronary Intervention. Cureus 2024; 16:e55291. [PMID: 38558614 PMCID: PMC10981776 DOI: 10.7759/cureus.55291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background The adoption of same-day discharge (SDD) in elective percutaneous coronary intervention (PCI) procedures offers potential benefits in terms of patient satisfaction and reduced healthcare costs. Despite these advantages, the safety and efficacy of SDD, especially among patients with diverse health profiles, are not fully understood. This study investigates the effects of patient-specific factors, including age, comorbidities, and discharge timing, on the clinical outcomes of elective PCI, focusing on the viability of SDD. Methods A prospective study was carried out at Lady Reading Hospital, Peshawar, Pakistan, involving 220 patients undergoing elective PCI from January to June 2023. This research compared the clinical outcomes of patients discharged on the same day with those who had extended hospital stays, examining the impact of age, comorbidities, and PCI success. Main outcome measures included post-procedure complications and hospital readmissions within 30 days. Results The study enrolled participants with an average age of 62 years, the majority (88%, n=194/220) of whom had comorbidities. Interestingly, 16% (n=35/220) of the participants were discharged on the same day, while the rest stayed longer in the hospital. Notably, those in the SDD group experienced significantly more complications and readmissions, with 95.14% (n=33/36) compared to only 16.22% (n=30/184) in their counterparts. Factors such as age, comorbidities, success of PCI, timing of discharge, and patient satisfaction emerged as significant predictors of the observed outcomes. Conclusion This study highlights the essential role of personalized care in discharge planning following elective PCI, advocating for a cautious approach towards SDD, especially for older patients and those with multiple health issues.
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Affiliation(s)
- Fahad R Khan
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
| | - Tariq Nawaz
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
| | - Muhammad Amin
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
| | - Wasim Sajjad
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
| | - Hassan Ali
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
| | - Sadam Hussain
- Cardiology, Lady Reading Hospital Peshawar, Peshawar, PAK
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El-Chami MF. Same day discharge after transvenous lead extraction: Balancing safety and efficiency. J Cardiovasc Electrophysiol 2024; 35:288-289. [PMID: 38105428 DOI: 10.1111/jce.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
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5
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Ginete WL, Groth NA, Rudeck MN, Renier CM, Benziger CP. Outcomes of same-day discharge following percutaneous coronary intervention in a rural population. Catheter Cardiovasc Interv 2023; 102:472-480. [PMID: 37483104 DOI: 10.1002/ccd.30762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. OBJECTIVE To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. METHODS There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Area codes 4-10 were used to define rural status. RESULTS A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio [aOR]: 0.20, 95% confidence interval [CI]: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. CONCLUSIONS SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.
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Affiliation(s)
- Wilson L Ginete
- Essentia Health Heart and Vascular Center, Duluth, Minnesota, USA
| | - Nicole A Groth
- Essentia Institute of Rural Health, Duluth, Minnesota, USA
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Krishnaswamy A, Isogai T, Brilakis ES, Nanjundappa A, Ziada KM, Parikh SA, Rodés-Cabau J, Windecker S, Kapadia SR. Same-Day Discharge After Elective Percutaneous Transcatheter Cardiovascular Interventions. JACC Cardiovasc Interv 2023; 16:1561-1578. [PMID: 37438024 DOI: 10.1016/j.jcin.2023.05.015] [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: 11/16/2022] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Percutaneous transcatheter interventions have evolved as standard therapies for a variety of cardiovascular diseases, from revascularization for atherosclerotic vascular lesions to the treatment of structural cardiac diseases. Concomitant technological innovations, procedural advancements, and operator experience have contributed to effective therapies with low complication rates, making early hospital discharge safe and common. Same-day discharge presents numerous potential benefits for patients, providers, and health care systems. There are several key elements that are shared across the spectrum of interventional cardiology procedures to create a successful same-day discharge pathway. These include appropriate patient and procedure selection, close postprocedural observation, predischarge assessments specific for each type of procedure, and the existence of a patient support system beyond hospital discharge. This review provides the rationale, available data, and a framework for same-day discharge across the spectrum of coronary, peripheral, and structural cardiovascular interventions.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice. Health Policy 2023; 132:104826. [PMID: 37087953 DOI: 10.1016/j.healthpol.2023.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
AIMS To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. METHODS AND RESULTS Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. CONCLUSION Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
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Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Shah JA, Kumar R, Solangi BA, Khan KA, Ahmed T, Khowaja S, Ali G, Zehra M, Sial JA, Karim M, Saghir T, Qamar N. One-year major adverse cardiovascular events among same-day discharged patients after primary percutaneous coronary intervention at a tertiary care cardiac centre in Karachi, Pakistan: a prospective observational study. BMJ Open 2023; 13:e067971. [PMID: 37037620 PMCID: PMC10111899 DOI: 10.1136/bmjopen-2022-067971] [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] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI. DESIGN 1-year follow-up analysis of a subset of patients from an existing prospective cohort study. SETTING Tertiary care cardiac hospital in Karachi, Pakistan. PARTICIPANTS Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year. OUTCOME MEASURE Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year. RESULTS 489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)). CONCLUSION A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.
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Affiliation(s)
- Jehangir Ali Shah
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Rajesh Kumar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Bashir Ahmed Solangi
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Kamran Ahmed Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tarique Ahmed
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Sanam Khowaja
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Gulzar Ali
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mehwish Zehra
- Department of Medicine, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Musa Karim
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Tahir Saghir
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Nadeem Qamar
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
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Diego-Nieto A, Núñez JC, Miñana G, Amat-Santos IJ, Salinas-Sanguino P, Mohandes M, Regueiro A, Pan M, Lacunza J, Caballero-Borrego J, Fernández-Díaz JA, Fernández Cisnal A, Santos-Martínez S, Gonzalo N, Vaquerizo B, Rivero F, Jurado-Román A, Abellán-Huerta J, Rumiz González E, Rondán-Murillo J, López Benito M, Astorga Burgo JC, Jiménez Mazuecos J, Bosa Ojeda F, Moreno-Ambroj C, Sabaté M, Ojeda S, Valdesuso Aguilar R, López Pérez M, Sanchis J, Campo-Prieto A, Escaned J, Goicolea J, Martín-Moreiras J. Seguridad y viabilidad del acceso radial para intervenciones coronarias percutáneas de oclusiones totales crónicas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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10
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Safety and feasibility of transradial access for percutaneous coronary intervention in chronic total occlusions. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2022; 76:253-260. [PMID: 35691552 DOI: 10.1016/j.rec.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transfemoral access is the most frequently used vascular approach in chronic total occlusion percutaneous coronary interventions (CTO-PCI). The aim of this study was to evaluate the safety and feasibility of a transradial access CTO-PCI program and its impact on angiographic and clinical results and length of hospital stay. METHODS Retrospective multicenter cohort study including 2550 consecutive CTO-PCI procedures included in a multicenter registry with accurate information on vascular access. A total of 896 procedures were performed as radial-only access while 1654 were performed through at least 1 femoral puncture. Clinical and angiographic data were collected. RESULTS The mean age was 66.3± 11.4 years. The mean Japan-chronic total occlusion score (2.7±0.3) was similar in the 2 groups. Successful revascularization was achieved in 2009 (79.6%) cases, 78.2% and 82.1% in the femoral and radial access cohorts, respectively (P=.002). Periprocedural in-hospital complications were observed in 5.1% and 2.3% (P=.02), with fewer access site-dependant vascular complications in the transradial cohort (2.3% vs 0.2%; P=.009). The mean length of hospital stay was significantly shorter in the transradial access group (0.89±1.4 vs 2.2±3.2 days, P<.001). CONCLUSIONS A transradial program for CTO-PCI is safe and effective in most CTO lesions. The transradial strategy has fewer vascular complications and shorter length of hospital stay without compromising the success rate.
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Bradley SM, Kaltenbach LA, Xiang K, Amin AP, Hess PL, Maddox TM, Poulose A, Brilakis ES, Sorajja P, Ho PM, Rao SV. Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2021; 14:1655-1666. [PMID: 34353597 DOI: 10.1016/j.jcin.2021.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of this study were to describe trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI) and to evaluate the association between trends in same-day discharge and patient outcomes. BACKGROUND Insights on contemporary use of same-day discharge following elective PCI are limited. METHODS In a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017, overall and hospital-level trends in same-day discharge were assessed. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was assessed. RESULTS A total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009 to 2017, the rate of same-day discharge increased from 4.3% to 19.5% for femoral-access PCI and from 9.9% to 39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access: 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (P for interaction <0.001). CONCLUSIONS In the past decade, a large increase in the use of same-day discharge following elective PCI was not associated with worse 30-day mortality or rehospitalization. Hospital-level variation in same-day discharge may represent an opportunity to reduce costs without compromising patient outcomes.
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Affiliation(s)
- Steven M Bradley
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
| | | | - Katelyn Xiang
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Amit P Amin
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul L Hess
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anil Poulose
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - P Michael Ho
- Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri, USA; VA Eastern Colorado Health Care System, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
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12
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Rashid M, Wu J, Timmis A, Curzen N, Clarke S, Zaman A, Nolan J, Shoaib A, Mohamed MO, de Belder MA, Deanfield J, Gale CP, Mamas MA. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med 2021; 290:88-100. [PMID: 33462815 PMCID: PMC8013521 DOI: 10.1111/joim.13246] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality. OBJECTIVES This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection. METHODS This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March and 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality. RESULTS A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19-positive and were more likely to present with non-ST-elevation acute myocardial infarction. The COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41-4.42) and 30-day mortality (aOR: 6.53; 95% CI: 5.1-8.36) compared to patients with the non-COVID-19 ACS. CONCLUSION COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline-recommended treatment and significant mortality hazard.
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Affiliation(s)
- Muhammad Rashid
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | - Nick Curzen
- Coronary Research Group, Faculty of Medicine, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Sarah Clarke
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Azfar Zaman
- Department of Cardiology, Freemen Hospital, Newcastle Upon Tyne, UK
| | - James Nolan
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Ahmad Shoaib
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Mohamed O Mohamed
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - Mamas A Mamas
- From the, Keele Cardiovascular Research Group, Institute for Prognosis Research, School of Primary Care, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.,Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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13
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Sahashi Y, Kawamura I, Aikawa T, Takagi H, Briasoulis A, Kuno T. Safety and feasibility of same-day discharge in patients receiving pulmonary vein isolation-systematic review and a meta-analysis. J Interv Card Electrophysiol 2021; 63:251-258. [PMID: 33630213 DOI: 10.1007/s10840-021-00967-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation (PVI). METHODS PubMed and Embase were systematically investigated from the inception to 20 July 2020. Studies on safety and feasibility of PVI for atrial fibrillation (AF) were included. Study-specific estimates were combined using one-group meta-analysis with a random-effects model. RESULTS Seven observational studies investigating the safety and feasibility of same-day discharge protocols were identified. Of a total of 3656 patients who have undergone PVI for AF, the overall complication rate was 0.80% (95% confidence interval [CI], 0.20-1.40%). The readmission within 30-day following same-day discharge protocol occurred at a pooled rate of 3.6% (95% CI, 0.0-8.4%). Frequent complications following the procedure were complications related to vascular access (0.38%; 95% CI, 0.18-0.58%), and phrenic nerve injury (0.19%; 95% CI, 0.05-0.33%). The reported complications in SDD group were mainly based on results among patients without perioperative complications. CONCLUSIONS The introduction of same-day discharge strategies might be safe and feasible in selected patients given the reported complication and re-admission rates in the current practice. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Yuki Sahashi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tadao Aikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th Street, New York, NY, 10003, USA.
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14
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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] [MESH Headings] [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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15
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Rashid Hons M, Gale Hons CP, Curzen Hons N, Ludman Hons P, De Belder Hons M, Timmis Hons A, Mohamed Hons MO, Lüscher Hons TF, Hains Hons J, Wu J, Shoaib A, Kontopantelis E, Roebuck C, Denwood T, Deanfield J, Mamas MA. Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out-of-Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England. J Am Heart Assoc 2020; 9:e018379. [PMID: 33023348 PMCID: PMC7763705 DOI: 10.1161/jaha.120.018379] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Studies have reported significant reduction in acute myocardial infarction-related hospitalizations during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends are associated with increased incidence of out-of-hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID-19 period (February 1-May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre-COVID-19 period (February 1-May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID-19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID-19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39-1.74). Patients experiencing OHCA during COVID-19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST-segment-elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; P<0.001) were significantly lower among the OHCA group during COVID-19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; P=0.05) in those with ST-segment-elevation myocardial infarction. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID-19 group (P<.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care and increased in-hospital mortality.
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Affiliation(s)
- Muhammad Rashid Hons
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Chris P Gale Hons
- Leeds Institute for Data Analytics University of Leeds Leeds UK.,Leeds Teaching Hospitals NHS Trust Leeds UK.,Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
| | - Nick Curzen Hons
- Coronary Research Group University Hospital Southampton and Faculty of Medicine University of Southampton Southampton UK
| | - Peter Ludman Hons
- Department of Cardiology Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Mark De Belder Hons
- National Institute for Cardiovascular Outcomes Research Barts Health NHS Trust London UK
| | | | - Mohamed O Mohamed Hons
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Thomas F Lüscher Hons
- Royal Brompton and Harefield Hospitals and Imperial College London UK.,Center for Molecular Cardiology University of Zürich Zürich Switzerland
| | - Julian Hains Hons
- National Institute for Cardiovascular Outcomes Research Barts Health NHS Trust London UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics University of Leeds Leeds UK.,Leeds Teaching Hospitals NHS Trust Leeds UK.,Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK
| | - Evangelos Kontopantelis
- Division of Population Health Health Services Research and Primary Care University of Manchester Manchester UK
| | | | | | - John Deanfield
- Institute of Cardiovascular Sciences University College London London UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.,Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK.,Department of Medicine Thomas Jefferson University Philadelphia PA
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16
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Taxiarchi P, Martin GP, Curzen N, Kinnaird T, Ludman P, Johnson T, Kwok CS, Rashid M, Kontopantelis E, Mamas MA. Rotational atherectomy and same day discharge: Safety and growth from a national perspective. Catheter Cardiovasc Interv 2020; 98:678-688. [PMID: 32845064 DOI: 10.1002/ccd.29228] [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: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We explore whether same day discharge (SDD) is a feasible and safe practice following rotational atherectomy (ROTA) treatment during elective percutaneous coronary intervention (PCI), and examine which baseline characteristics are independently associated with SDD. BACKGROUND SDD following elective ROTA PCI is not recommended as per the recent SCAI consensus. However, reports show it is practiced and no previous study has evaluated its safety and feasibility. METHODS Our dataset included 4,591 patients undergoing elective ROTA PCI in England & Wales within an 8-years period. Independent associations with SDD were quantified via a multiple logistic regression model and the BCIS 30-day mortality risk model was used to evaluate the safety of SDD. RESULTS The majority of elective ROTA PCI cases remain at the hospital for overnight (ON) observation, although SDD rates increased substantially from 6.7% in 2007 to 35.5% in 2014. The use of glycoprotein IIb/IIIa antagonists, Q wave AMI, left main PCI and valvular heart disease were independently associated with ON, while patients operated underwent transradial PCI were more likely to be SDD (OR = 1.77, 95% CI [1.45-2.15]). Over the study period, observed mortality rates were not significantly higher than those expected from the BCIS risk model. CONCLUSIONS Our findings did not show superiority of the ON strategy over SDD for higher risk cases undergoing elective ROTA PCI, in terms of 30-day mortality. This is the first study to examine the safety of SDD after elective ROTA PCI and more should follow.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Center, Manchester, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK.,Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK.,Thomas Jefferson University, Philadelphia, Pennsylvania
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17
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Borges Santos M. Same-day discharge after elective percutaneous transluminal coronary angioplasty: An instruction manual and call for increased uptake in a burdened National Health Service. Rev Port Cardiol 2020; 39:451-452. [PMID: 32768264 PMCID: PMC7403124 DOI: 10.1016/j.repc.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Miguel Borges Santos
- Serviço de Cardiologia, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
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18
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Ramsingh R, Maharaj D, Angelini G, Rampersad RD. Safety and Cost-Savings of Same-Day Discharge Trans-Radial Percutaneous Coronary Intervention in Trinidad and Tobago. Cureus 2020; 12:e9568. [PMID: 32905543 PMCID: PMC7473603 DOI: 10.7759/cureus.9568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Same-day discharge percutaneous coronary interventions (SDD-PCI) may be quite impactful on healthcare burden for small island developing states (SIDS) such as Trinidad and Tobago. Methods: From June 2012 to November 2014, 11 patients underwent SDD trans-radial PCI and followed up at one-month and three months. Data was retrospectively reviewed from a prospectively entered unit-maintained cardiology database. Baseline patient characteristics, in-hospital expenditure, and complications were assessed. Descriptive statistical analysis was performed in Microsoft Excel. Results: The mean age at SDD-PCI was 50.90±9.96 and nine were male. Nine patients were of East Indian Caribbean ethnicity. Six were diabetic and five were hypertensive. Procedural success was 100% with no major early complication or three-months complications; patient satisfaction was achieved with a potential in-hospital savings up to $1480 USD per patient. Conclusion: This SDD approach for elective trans-radial PCI may be safe and cost-effective in properly selected patients and merits a review of relevant policy issues in Trinidad and Tobago.
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Affiliation(s)
- Richard Ramsingh
- Cardiovascular Disease, Caribbean Heart Care Medcorp, Port-of-Spain, TTO
| | - Dale Maharaj
- Vascular Surgery, Caribbean Vascular & Vein Clinic, Port-of-Spain, TTO
| | - Gianni Angelini
- Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, GBR
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19
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Borges Santos M. Same-day discharge after elective percutaneous transluminal coronary angioplasty: An instruction manual and call for increased uptake in a burdened National Health Service. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Will the COVID-19 pandemic accelerate the implementation of single-day coronary angioplasty in Poland? Adv Cardiol 2020; 16:184-186. [PMID: 32636903 PMCID: PMC7333191 DOI: 10.5114/aic.2020.95852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 12/03/2022]
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21
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Box LC, Blankenship JC, Henry TD, Messenger JC, Cigarroa JE, Moussa ID, Snyder RW, Duffy PL, Carr JG, Tukaye DN, Ang L, Shah B, Rao SV, Mahmud E. SCAI
position statement on the performance of percutaneous coronary intervention in ambulatory surgical centers. Catheter Cardiovasc Interv 2020; 96:862-870. [DOI: 10.1002/ccd.28991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital Cincinnati Ohio USA
| | | | | | - Issam D. Moussa
- Carle Health System, Carle Illinois College of Medicine Champaign Illinois USA
| | | | - Peter L. Duffy
- Appalachian Regional Healthcare System Boone North Carolina USA
| | - Jeffrey G. Carr
- CardiaStream Tyler Cardiac and Endovascular Center Tyler Texas USA
| | | | - Lawrence Ang
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
| | - Binita Shah
- New York University School of Medicine New York New York USA
| | - Sunil V. Rao
- Duke University Health System Durham North Carolina USA
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center La Jolla California USA
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22
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Showkathali R, Yalamanchi R, Oomman A. Early discharge of patients (within 24 h) after percutaneous coronary intervention is feasible and safe in Indian setup. Indian Heart J 2020; 72:126-127. [PMID: 32534686 PMCID: PMC7296253 DOI: 10.1016/j.ihj.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/28/2020] [Indexed: 11/23/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is the commonest cardiac procedure in most centres in India. Unlike in most western countries, patients who undergo PCI in India are discharged after a few days. We undertook an observational study of 100 consecutive patients to evaluate the outcome of early discharge (within 24 h) after uncomplicated elective PCI. This showed that early discharge is feasible and safe; and most patients felt comfortable with early discharge. It is the responsibility of the interventional cardiologist to educate and reassure these uncomplicated PCI patients about the safety of this approach.
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Affiliation(s)
- Refai Showkathali
- Department of Cardiology, Apollo Hospitals, Greams Road, Chennai, India.
| | | | - Abraham Oomman
- Department of Cardiology, Apollo Hospitals, Greams Road, Chennai, India
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23
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Gokhale S, Desai B, Twing A, Dickens H, Shroff A. Same-Day Discharge After Outpatient PCI in a VA Hospital: Shared Decision Making and the VA MISSION Act. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1369-1373. [PMID: 32513603 DOI: 10.1016/j.carrev.2020.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The VA Mission Act of 2018 sought to increase access to local care facilities for Veterans meeting certain eligibility criteria including a drive time of >60 min from a VA facility. As part of an ongoing review of our VA program's same day discharge (SDD) program following elective percutaneous coronary intervention (PCI), we investigated whether the distance criteria of the VA Mission Act had any impact on overall safety outcomes. METHODS We performed a single center, retrospective study in patients who underwent outpatient PCI between 2013 and 2019. We stratified patients into an overnight observation (ON) and SDD group. We used Google Maps in order to calculate patient home distance to the Jesse Brown Veterans Affairs Hospital (JBVA). Primary endpoints included all-cause death andmajor adverse cardiac events (MACE; cardiovascular death, myocardial infarction, stroke, and/or target vessel revascularization). Secondary outcomes included total unplanned interactions with the healthcare system. Outcomes were analyzed at 30 days after PCI. RESULTS There were 76 patients in the SDD group. The SDD group had a median drive time of 80 min from the JBVA. Regarding primary outcomes, there were no cases of MACE in either group and there was no statistically significant difference in terms of all-cause mortality (ON: 1.3%, SDD: 0%, p = .5) 30 days following PCI. All secondary outcomes at 30 days did not demonstrate a statistically significant difference between either group. CONCLUSION Same day discharge following successful PCI procedures appears safe. In response to the VA Mission Act, drive time and distance travelled did not appear to impact outcomes. SUMMARY Same day discharge in select patients at our VA hospital was both safe and feasible. Neither drive time nor distance travelled affected overall outcomes in response to the 2018 VA MISSION Act. As such, shared decision making between patients and physicians remains essential to ensure Veterans continue to receive high quality care that is in their best medical interest.
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Affiliation(s)
- Sanket Gokhale
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Binnie Desai
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Aamir Twing
- Department of Internal Medicine, University of Illinois-, Chicago, United States of America.
| | - Helena Dickens
- University of Illinois at Urbana-Champaign, United States of America.
| | - Adhir Shroff
- Cardiology Section, University of Illinois-, Chicago, United States of America.
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24
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Riley RF, Henry TD, Mahmud E, Kirtane AJ, Brilakis ES, Goyal A, Grines CL, Lombardi WL, Maran A, Rab T, Tremmel JA, Truesdell AG, Yeh RW, Zhao DX, Jaffer FA. SCAI
position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease. Catheter Cardiovasc Interv 2020; 96:346-362. [DOI: 10.1002/ccd.28994] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Cincinnati Ohio USA
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center University of California San Diego La Jolla California USA
| | - Ajay J. Kirtane
- Center for Interventional Vascular Therapy Columbia University Medical Center New York New York USA
| | | | | | | | | | - Anbukarasi Maran
- Medical University of South Carolina North Charleston South Carolina USA
| | | | | | | | - Robert W. Yeh
- Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - David X. Zhao
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
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Cost-effectiveness and Outcomes with Early or Same-Day Discharge After Elective Percutaneous Coronary Intervention. Curr Cardiol Rep 2020; 22:42. [PMID: 32430629 DOI: 10.1007/s11886-020-01286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Shorter hospital stay after percutaneous coronary intervention (PCI) can provide economic advantage. Same-day discharge (SDD) after transradial PCI is thought to reduce the cost of care while maintaining the quality and safety. This review summarizes the current knowledge of the benefits and safety of this concept. RECENT FINDINGS Increase in rate of transradial PCI over the last two decades has resulted in recent growth in rate of acceptance of SDD after a successful procedure. SDD is shown to result in savings of $3500 to $5200 per procedure with comparable adverse event rate of traditional discharge processes. SDD after PCI is shown to be safe and results in cost advantage maintaining the safety profile. The acceptance rate of SDD is still not optimum, and further market penetration of SDD practice would be achieved only if the institutional and operator preference barriers are addressed.
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Taxiarchi P, Martin GP, Kinnaird T, Curzen N, Ahmed J, Ludman P, De Belder M, Shoaib A, Rashid M, Kontopantelis E, Mamas MA. Contributors to the Growth of Same Day Discharge After Elective Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2020; 13:e008458. [DOI: 10.1161/circinterventions.119.008458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient’s clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region.
Methods:
The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R
2
in each study year.
Results:
The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%–52.4%) in 2007 to 43.4% (95% CI, 39.9%–46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%–10.9%) to 19.8% (95% CI, 16.7%–22.4%). Between patients’ clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%–16.4%) to 7.1% (95% CI, 5.5%–8.8%) and from 3.6% (95% CI, 2.3%–5.1%) to 11.8% (95% CI, 9.4%–14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities.
Conclusions:
Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.
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Affiliation(s)
- Paraskevi Taxiarchi
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Glen P. Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (P.T., G.P.M.)
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.)
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Javed Ahmed
- Department of Cardiology, Freeman Hospital, Newcastle, United Kingdom (J.A.)
| | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Mark De Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.)
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele (T.K., A.S., M.R., M.A.M.)
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (A.S., M.R., M.A.M.)
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA (M.A.M.)
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, United Kingdom (E.K., M.A.M.)
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Reply: Same-Day Discharge After Elective Percutaneous Intervention: Where Is the Barrier? JACC Cardiovasc Interv 2019; 12:2324-2325. [PMID: 31753304 DOI: 10.1016/j.jcin.2019.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022]
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Lozano I, Rondan J, Vegas JM, Segovia E. Same-Day Discharge After Elective Percutaneous Intervention: Where Is the Barrier? JACC Cardiovasc Interv 2019; 12:2324. [PMID: 31753305 DOI: 10.1016/j.jcin.2019.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
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Stouffer GA, Means GT, Yeung M. To Stay or Not to Stay: That Is the Question. JACC Cardiovasc Interv 2019; 12:1495-1496. [PMID: 31395219 DOI: 10.1016/j.jcin.2019.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 11/17/2022]
Affiliation(s)
- George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Greg T Means
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Mike Yeung
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
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