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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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Danilushkin YV, Basinkevich AB, Shamrina NS, Bubnov DS, Silvestrova GA, Ageev FT, Matchin YG. [Remote electrocardiogram telemonitoring after endovascular interventions on the coronary arteries]. TERAPEVT ARKH 2022; 94:1062-1066. [PMID: 36286756 DOI: 10.26442/00403660.2022.09.201846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
AIM To evaluate the effectiveness of a new system for telemetric electrocardiogram (ECG) monitoring in patients after endovascular interventions (EI) on the coronary arteries (CA). MATERIALS AND METHODS 168 patients with chronic ischemic heart disease who underwent EI on the CA on an outpatient basis, and during routine hospitalization, followed by telemetric ECG-monitoring after interventions were included. The monitoring was carried out using a three-channel telemetric recorder Astrocard HE3 (Russia), which provides continuous monitoring of 3-lead ECG for a long time. RESULTS The telemetry was successfully performed in all 168 (100%) patients. In 165 (98%) patients, the quality of the recording was regarded as good, in 3 (2%) as satisfactory. There were no cases of disconnection of the device, no interruptions in recording. During the observation period, no life-threatening arrhythmia revealed. When comparing the telemetry results in different groups of patients, there were no significant differences in the incidence of arrhythmia. Patients with a history of percutaneous coronary interventions were questioned; according to which 92% of respondents reported that they felt more comfortable after the intervention followed by telemetric ECG-monitoring. CONCLUSION Carrying out telemetric ECG-monitoring after EI on the CA improves the quality of observation after the procedure, promotes early discharge of patients, makes the intervention more comfortable and safe. The introduction of this technique into clinical practice will make it possible to more widely use the outpatient approach when carrying out EI, and to increase the turnover of specialized beds and the efficiency of the work of medical institutions.
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Affiliation(s)
| | | | - N S Shamrina
- Chazov National Medical Research Center of Cardiology
| | - D S Bubnov
- Chazov National Medical Research Center of Cardiology
| | | | - F T Ageev
- Chazov National Medical Research Center of Cardiology
| | - Y G Matchin
- Chazov National Medical Research Center of Cardiology
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Tajabadi M, Goran Orimi H, Ramzgouyan MR, Nemati A, Deravi N, Beheshtizadeh N, Azami M. Regenerative strategies for the consequences of myocardial infarction: Chronological indication and upcoming visions. Biomed Pharmacother 2021; 146:112584. [PMID: 34968921 DOI: 10.1016/j.biopha.2021.112584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Heart muscle injury and an elevated troponin level signify myocardial infarction (MI), which may result in defective and uncoordinated segments, reduced cardiac output, and ultimately, death. Physicians apply thrombolytic therapy, coronary artery bypass graft (CABG) surgery, or percutaneous coronary intervention (PCI) to recanalize and restore blood flow to the coronary arteries, albeit they were not convincingly able to solve the heart problems. Thus, researchers aim to introduce novel substitutional therapies for regenerating and functionalizing damaged cardiac tissue based on engineering concepts. Cell-based engineering approaches, utilizing biomaterials, gene, drug, growth factor delivery systems, and tissue engineering are the most leading studies in the field of heart regeneration. Also, understanding the primary cause of MI and thus selecting the most efficient treatment method can be enhanced by preparing microdevices so-called heart-on-a-chip. In this regard, microfluidic approaches can be used as diagnostic platforms or drug screening in cardiac disease treatment. Additionally, bioprinting technique with whole organ 3D printing of human heart with major vessels, cardiomyocytes and endothelial cells can be an ideal goal for cardiac tissue engineering and remarkable achievement in near future. Consequently, this review discusses the different aspects, advancements, and challenges of the mentioned methods with presenting the advantages and disadvantages, chronological indications, and application prospects of various novel therapeutic approaches.
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Affiliation(s)
- Maryam Tajabadi
- School of Metallurgy and Materials Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran 16844, Iran
| | - Hanif Goran Orimi
- School of Metallurgy and Materials Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran 16844, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Roya Ramzgouyan
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Alireza Nemati
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Beheshtizadeh
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mahmoud Azami
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Iran; Regenerative Medicine Group (REMED), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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4
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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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5
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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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Rao G, Singh A, Gandhotra P, Meraj P, Jauhar S, Kuvin J, Epstein L, Naidu S, Arora R, Kaplan B, Jauhar R. Paradigm Shifts in Cardiac Care: Lessons Learned From COVID-19 at a Large New York Health System. Curr Probl Cardiol 2020; 46:100675. [PMID: 32888698 PMCID: PMC7833557 DOI: 10.1016/j.cpcardiol.2020.100675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has overwhelmed healthcare systems around the world, resulting in morbidity, mortality, and a dramatic economic downturn In the United States. Urgent responses to the pandemic halted routine hospital workflow in an effort to increase hospital capacity, maintain staffing, and ration protective gear. Most notably, New York saw the largest surge of COVID-19 cases nationwide. Healthcare personnel and physician leaders at Northwell Health, the largest healthcare system in New York, have worked together to successfully implement operational changes resulting in a paradigm shift in cardiac care delivery. In this manuscript, we detail specific protocol adjustments made in our cardiology department, cardiology service line, and healthcare system in the face of the COVID-19 pandemic. We discuss the sustainability of this shift moving forward and the opportunity to optimize care for cardiovascular patients in the post COVID-19 era.
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7
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Basinkevich AB, Matchin YG, Ageev FT. [Safety and clinical-cost effectiveness of percutaneous coronary interventions with overnight hospitalization]. TERAPEVT ARKH 2020; 92:127-134. [PMID: 32598710 DOI: 10.26442/00403660.2020.04.000532] [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: 05/19/2020] [Indexed: 11/22/2022]
Abstract
New methods and treatment plans for patients with chronic coronary artery disease after endovascular interventions are currently introduced into clinical practice. It allows reducing hospital stay down to 24 hour, with discharge the next morning. This approach is called overnight stay. Using a similar strategy increases the availability of various types of endovascular interventions, shorter waiting lists, and cut the cost of treatment due to a reduced hospital stay.
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Affiliation(s)
| | - Y G Matchin
- National Medical Research Center of Cardiology
| | - F T Ageev
- National Medical Research Center of Cardiology
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8
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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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Danilushkin YV, Matchin YG, Shamrina NS, Bubnov DS, Atanesyan RV, Mitroshkin MG, Basinkevich AB, Ageev FT. Various approaches for peforming an outpatient coronary angiography. TERAPEVT ARKH 2019; 91:74-82. [PMID: 31094480 DOI: 10.26442/00403660.2019.04.000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM To study the safety and clinical efficacy of an outpatient coronary angiography in various groups of patients according to a 6-year experience of the laboratory of endovascular diagnostic and treatment methods in the outpatient setting of the NMRC of Cardiology. MATERIALS AND METHODS 2166 patients which underwent an outpatient coronary agiography from March 2009 to December 2014 were included. The success criteria was the successful completion of the procedure without the occurrence of major cardiovascular complications (death, transmural myocardial infarction; acute cerebrovascular accident, emergency cardiac surgery). RESULTS All 2166 patients included in the study were divided into 2 groups: Group 1 - 1316 patients who were discharged home several hours after the study; Group 2 - 850 patients directed from hospitals without catheterization laboratories with the same-day discharge back to the referring hospital. From a clinical point of view, in the second group there were more severe patients. However, the study was successfully completed in all patients in both groups. There were no major adverse cardiovascular complications during the procedure and within 24 hours. In the 1st group, unplanned hospitalization occurred in 2.1% of cases, the cause of which in 93% of cases was the detection during angiography of a critical lesion ≥70% of the left main coronary artery. CONCLUSION In our work, the incidence of complications was extremely low and not significantly different in both groups of patients. This is due to the fact that in patients with a more severe symptoms underwent a preliminary stabilization of their clinical condition. The introduction of outpatient technologies will optimize the invasive diagnostics and reduce the costs associated with hospitalization.
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Affiliation(s)
- Yu V Danilushkin
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - Yu G Matchin
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - N S Shamrina
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - D S Bubnov
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - R V Atanesyan
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - M G Mitroshkin
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - A B Basinkevich
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - F T Ageev
- A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology, Ministry of Health of Russian Federation, Moscow, Russia
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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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11
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Lu H, Guan W, Zhou Y, Bao H. Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14025. [PMID: 30608455 PMCID: PMC6344175 DOI: 10.1097/md.0000000000014025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI. METHODS The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software. RESULTS A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31-1.79; P = .51), mortality (OR: 0.26, 95% CI: 0.06-1.06; P = .06), stroke (OR: 1.46, 95% CI: 0.72-2.94; P = .29), arrhythmia (OR: 1.30, 95% CI: 0.64-2.63; P = .47), hematoma (OR: 1.00, 95% CI: 0.60-1.66; P = 1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22-12.85; P = .62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71-5.70; P = .19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86-50.66; P = .07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07-0.44; P = .0002). CONCLUSIONS In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.
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Affiliation(s)
- Hongtao Lu
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Wenjun Guan
- Jingzhou Central Hospital of Cardiology, The Second Clinical Medical College, Yangtze University, Jingzhou
| | - Yanhua Zhou
- Jingzhou First People's Hospital, the First Clinical Medical College
| | - Hong Bao
- Jiangling County People's Hospital of Cardiology, Jingzhou, Hubei, People's Republic of China
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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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Din JN, Snow TM, Rao SV, Klinke WP, Nadra IJ, Della Siega A, Robinson SD. Variation in practice and concordance with guideline criteria for length of stay after elective percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:715-722. [DOI: 10.1002/ccd.26992] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/20/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jehangir N. Din
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Thomas M. Snow
- Dorset Heart Centre, Royal Bournemouth Hospital; Bournemouth United Kingdom
| | - Sunil V. Rao
- Duke Clinical Research Institute; Durham North Carolina
| | - W. Peter Klinke
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
| | - Imad J. Nadra
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Anthony Della Siega
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
| | - Simon D. Robinson
- Victoria Heart Institute Foundation; Victoria British Columbia Canada
- Royal Jubilee Hospital; Victoria British Columbia Canada
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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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Campo G, Menozzi M, Guastaroba P, Vignali L, Belotti LMB, Casella G, Berti E, Solinas E, Guiducci V, Biscaglia S, Pavasini R, De Palma R, Manari A. Same-day transfer for the invasive strategy of patients with non-ST-segment elevation acute coronary syndrome admitted to spoke hospitals: Data from the Emilia-Romagna Regional Network. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:428-434. [DOI: 10.1177/2048872615610867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/20/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy
- Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA) Center, Italy
| | - Mila Menozzi
- Unità Operativa di Cardiologia, Ospedale degli Infermi, Rimini, Italy
| | | | - Luigi Vignali
- Divisione di Cardiologia, Ospedale Maggiore, Parma, Italy
| | | | - Gianni Casella
- Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
| | - Elena Berti
- Agenzia Sanitaria Regionale Regione Emilia-Romagna, Italy
| | - Emilia Solinas
- Divisione di Cardiologia, Ospedale Maggiore, Parma, Italy
| | - Vincenzo Guiducci
- Unità Operativa di Cardiologia Interventistica, Ospedale S. Maria Nuova, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Italy
| | | | - Antonio Manari
- Unità Operativa di Cardiologia Interventistica, Ospedale S. Maria Nuova, Italy
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Chen Y, Marshall A, Lin F. Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review. Worldviews Evid Based Nurs 2016; 13:371-379. [PMID: 27171576 DOI: 10.1111/wvn.12163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
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Affiliation(s)
- Yingyan Chen
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Andrea Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalized Patients (NCREN), Menzies Health Institute Queensland; Gold Coast Hospital and Health Service, Nursing and Midwifery Education and Research Unit, all at Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Frances Lin
- Program Director, Senior Lecturer, School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Clavijo LC, Cortes GA, Jolly A, Tun H, Mehra A, Gaglia MA, Shavelle D, Matthews RV. Same-day discharge after coronary stenting and femoral artery device closure: A randomized study in stable and low-risk acute coronary syndrome patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:155-61. [DOI: 10.1016/j.carrev.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
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Safety and Efficacy of Same-Day Discharge Following Elective Percutaneous Coronary Intervention, Including Evaluation of Next Day Troponin T Levels. Heart Lung Circ 2015; 24:368-76. [DOI: 10.1016/j.hlc.2014.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/22/2022]
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Singh VR, Jayaraman B, Satheesh S, Ananthakrishna Pillai A. Safety and outcomes of day care based coronary angioplasty--First report from India. Indian Heart J 2015; 67:108-13. [PMID: 26071288 PMCID: PMC4475823 DOI: 10.1016/j.ihj.2015.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The concept of day care based coronary angioplasty might be frugal especially in countries like India where epidemic of coronary disease is enduring and healthcare delivery systems are limited. Published literature addressing the feasibility and safety of day care percutaneous coronary interventions (PCI) is lacking from our country. OBJECTIVES To study the safety and outcomes in stable cardiac patients undergoing day care coronary angioplasty. METHODS A single centre nonrandomized active controlled trial of patients undergoing elective transradial coronary angioplasty and same day discharge after triaging was compared with a conventional arm of hospital overnight stay. RESULTS Fifty six patients with stable coronary artery disease underwent day care angioplasty. There were no major immediate adverse cardiac and cerebral events noted in the first 24 h. The procedural result followed by a 6-h observation period allowed adequate triage of patients to same-day discharge or to extended clinical observation. Apart from one possible stent thrombosis on day 3 in the treatment arm where the patent received fibrinolytic treatment in a local hospital, there were no major adverse cardiac or cerebral vascular events in the study group. The six month clinical follow up in the day care procedure group was also unevenful for any major adverse cardiac events. CONCLUSION The study albeit small shows the feasibility and safety of day care PCI in the Indian scenario. It did not lead to additional complications compared with overnight stay. Triage of patients for an extended observation period can be performed adequately on the basis of clinical and procedural criteria.
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Affiliation(s)
- Vivek Raj Singh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Balachander Jayaraman
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
| | - Ajith Ananthakrishna Pillai
- Associate Professor, Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
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HODKINSON EMILYC, RAMSEWAK ADESH, MURPHY JOHNCONLETH, SHAND JAMESA, MCCLELLAND ANTHONYJ, MENOWN IANBA, HANRATTY COLMG, SPENCE MARKS, WALSH SIMONJ. An Audit of Outcomes After Same-Day Discharge Post-PCI in Acute Coronary Syndrome and Elective Patients. J Interv Cardiol 2013; 26:570-7. [DOI: 10.1111/joic.12065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - ADESH RAMSEWAK
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | | | - JAMES A. SHAND
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - ANTHONY J. MCCLELLAND
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - IAN B. A. MENOWN
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - COLM G. HANRATTY
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - MARK S. SPENCE
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - SIMON J. WALSH
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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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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Antonsen L, Jensen LO, Thayssen P. Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access: a single-center experience. Am Heart J 2013; 165:393-9. [PMID: 23453109 DOI: 10.1016/j.ahj.2012.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/11/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ongoing development in percutaneous coronary intervention (PCI) techniques and closing devices facilitates same-day-discharge in patients undergoing uncomplicated PCI procedures. We examined the safety and outcome in low-risk patients discharged the same day as PCI with femoral access was performed. METHODS From January 1, 2010, through December 31, 2010, the outcomes of same-day discharge in 355 (19.6%) of in total 1,809 patients undergoing PCI were analyzed. Composite end point included major adverse cardiac or cerebral events and/or bleeding/vascular complications within 24 hours and 30 days. Major adverse cardiac and cerebral events were defined as cardiac death, myocardial infarction, stroke, coronary artery bypass grafting, or repeat PCI. RESULTS The mean age of the study population was 64.5 years (40.0-93.0 years), 17.3% of the patients were ≥75 years old. The indication for PCI was: stable angina pectoris (n = 277, 78.0%) and unstable angina pectoris/non-ST-segment elevation myocardial infarction (n = 78, 22.0%). In all patients femoral access was used, and the puncture site was closed with the closing-device AngioSeal. No major adverse cardiac and cerebral events were seen within 24 hours or 30 days except in 1 patient who had target lesion revascularization done as PCI 4 days post-procedure. Three patients had bleeding/vascular complications; 2 patients were re-admitted within 24 hours due to access-site hematomas, which were treated with manual compression and bed-rest regimes. One patient developed a pseudoaneurysm within 12 hours post-procedure. CONCLUSIONS Same-day-discharge after uncomplicated PCI using femoral access is safe when patients are properly selected. The strategy may improve and benefit health costs in the future.
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Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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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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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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Saab F, Ionescu C, J. Schweiger M. Bleeding risk and safety profile related to the use of eptifibatide: a current review. Expert Opin Drug Saf 2012; 11:315-24. [DOI: 10.1517/14740338.2012.650164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leesar MA, Satran A, Yalamanchili V, Helmy T, Abdul-Waheed M, Wongpraparut N. The impact of fractional flow reserve measurement on clinical outcomes after transradial coronary stenting. EUROINTERVENTION 2011; 7:917-23. [DOI: 10.4244/eijv7i8a145] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jeremy RW. Early discharge after percutaneous intervention--we can but should we? Heart Lung Circ 2011; 20:351-2. [PMID: 21575842 DOI: 10.1016/s1443-9506(11)00265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Safety of same day discharge following percutaneous coronary intervention. Heart Lung Circ 2011; 20:353-6. [PMID: 21429794 DOI: 10.1016/j.hlc.2011.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a body of literature reporting the safety of discharging patients the same day as percutaneous coronary revascularisation. Nevertheless, overnight stay continues to be the general standard of care. METHODS Over a single calendar year, 130 patients having elective, percutaneous coronary revascularisation were discharged home the day of the procedure with the majority of procedures using radial access. Patients were observed post procedure for six hours and if no problems occurred, discharge was undertaken. The purpose of the study was to assess complications in the 24 hours following discharge. RESULTS Within the following 24 hours post discharge, there were no complications reported including bleeding, recurrent ischaemia, or hospitalisation. CONCLUSION Same day discharge following elective percutaneous revascularisation appears both efficacious and safe with a low risk of post discharge complications.
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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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Outpatient Percutaneous Coronary Interventions. JACC Cardiovasc Interv 2010; 3:1020-1. [DOI: 10.1016/j.jcin.2010.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/18/2010] [Accepted: 09/01/2010] [Indexed: 11/18/2022]
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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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Self-Care Behaviour and Factors Associated with Patient Outcomes Following Same-Day Discharge Percutaneous Coronary Intervention. Eur J Cardiovasc Nurs 2009; 8:190-9. [DOI: 10.1016/j.ejcnurse.2008.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 12/11/2008] [Accepted: 12/15/2008] [Indexed: 11/20/2022]
Abstract
Background: The demand for percutaneous coronary intervention (PCI) exerts constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and improve access to care. Aim: The purpose of this study was to describe elective same-day discharge PCI patients' self-care behaviour in the two to five days following their procedure, and the factors associated with cardiac self-efficacy (CSE) and self-care agency (SCA). Methods: Using a cross-sectional correlational design, 98 consecutive patients were contacted by telephone, following PCI, and asked about their CSE, SCA, and adherence to discharge recommendations. Associations between selected variables were explored through multiple regression analysis. Results: The findings revealed a high degree of adherence to discharge recommendations, although participants' appreciation of the long term management of their chronic disease was limited. Factors associated with lower levels of CSE and SCA included the burden of having additional chronic co-morbidities, living alone and lacking social support, and a positive screening for psychosocial distress. Conclusion: Same-day discharge PCI presents a sustainable option for delivery of care for most patients. Some clients may require additional support to manage the transition between acute intervention and chronic disease management.
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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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Movahed MR, Ramaraj R, Jamal MM, Hashemzadeh M. Nationwide trends in the utilization of multivessel percutaneous coronary intervention (MVPCI) in the United States across different gender and ethnicities. J Interv Cardiol 2009; 22:247-51. [PMID: 19490351 DOI: 10.1111/j.1540-8183.2009.00467.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate nationwide trends in the utilization of Multivessel Percutaneous Coronary Intervention (MVPCI) in the past compared to recent years using a large database from 1988 to 2004. METHOD The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted rate for multivessel percutaneous coronary intervention (MVPCI) from 1988 to 2004. Specific ICD-9-CM codes for MVPCI were used to compile the data. Patient demographic data were also analyzed from the database. RESULTS According to the NIS database, MVPCI was performed in 241,319 patients from 1988 to 2004. Males underwent MVPCI twice as many as compared to females (male: 67.87%, female 32.13%). The mean age for these patients was 64.89 +/- 11.84 years old. From 1988, the age-adjusted rate for MVPCI gradually increased to more than three times in 1998 [(6.62 per 100,000 (95%CI = 5.92-7.33) in 1988 to 23.92 per 100,000 (95%CI = 21.62-26.22, P < 0.01) in 1998] and accelerated to more than 6 times that of 1988 at the end of the study in 2004 (41.50 per 100,000 (95%CI = 37.84-45.16). In recent years, this trend was similar for both genders and ethnicities. CONCLUSION The utilization of MVPCI has increased six times from 1988 to 2004, with acceleration in recent years. The cause of this acceleration is most likely related to the advancement in the percutaneous coronary interventional techniques.
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Affiliation(s)
- Mohammad Reza Movahed
- Division of Cardiology, The Southern Arizona VA Health Care System, Tucson, Arizona 85724, USA.
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Abbreviated Infusion of Eptifibatide After Successful Coronary Intervention. J Am Coll Cardiol 2009; 53:837-45. [DOI: 10.1016/j.jacc.2008.09.060] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 09/04/2008] [Accepted: 09/08/2008] [Indexed: 11/21/2022]
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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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40
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Gilchrist IC, French JK. Radial access for cardiac catheterization is not radical. Am Heart J 2008; 156:805-7. [PMID: 19061690 DOI: 10.1016/j.ahj.2008.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 08/03/2008] [Indexed: 11/17/2022]
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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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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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45
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Ziakas A, Klinke P, Mildenberger R, Fretz E, Williams M, Siega AD, Kinloch D, Hilton D. Safety of Same Day Discharge Radial PCI in Patients Under and Over 75 Years of Age. Int Heart J 2007; 48:569-78. [DOI: 10.1536/ihj.48.569] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Peter Klinke
- Department of Cardiology, Royal Jubilee Hospital
| | | | - Eric Fretz
- Department of Cardiology, Royal Jubilee Hospital
| | | | | | | | - David Hilton
- Department of Cardiology, Royal Jubilee Hospital
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Bertrand OF, De Larochellière R, Rodés-Cabau J, Proulx G, Gleeton O, Nguyen CM, Déry JP, Barbeau G, Noël B, Larose E, Poirier P, Roy L. A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation. Circulation 2006; 114:2636-43. [PMID: 17145988 DOI: 10.1161/circulationaha.106.638627] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background—
Systematic use of coronary stents and optimized platelet aggregation inhibition has greatly improved the short-term results of percutaneous coronary interventions. Transradial percutaneous coronary interventions have been associated with a low risk of bleeding complications. It is unknown whether moderate- and high-risk patients can be discharged safely the same day after uncomplicated transradial percutaneous coronary interventions.
Methods and Results—
We randomized 1005 patients after a bolus of abciximab and uncomplicated transradial percutaneous coronary stent implantation either to same-day home discharge and no infusion of abciximab (group 1, n=504) or to overnight hospitalization and a standard 12-hour infusion of abciximab (group 2, n=501). The primary composite end point of the study was the 30-day incidence of any of the following events: death, myocardial infarction, urgent revascularization, major bleeding, repeat hospitalization, access site complications, and severe thrombocytopenia. The noninferiority of same-day home discharge and bolus of abciximab only compared with overnight hospitalization and abciximab bolus and infusion was evaluated. Two thirds of patients presented with unstable angina and ≈20% presented with high-risk acute coronary syndrome prior to the procedure. The incidence of the primary end point was 20.4% in group 1 and 18.2% in group 2 (
P
=0.017 for noninferiority) with a troponin T–based definition of myocardial infarction; the incidence of the primary end point was 11.1% in group 1 and 9.6% in group 2 (
P
=0.0004 for noninferiority) with a creatinine kinase myocardial band–based definition of myocardial infarction. No death occurred. Rate of major bleeding in both groups was extremely low at 0.8% and 0.2%, respectively. From 504 patients randomized in group 1, 88% were discharged home the same day.
Conclusion—
Our data suggest that same-day home discharge after uncomplicated transradial coronary stenting and bolus only of abciximab is not clinically inferior, in a wide spectrum of patients, to the standard overnight hospitalization and a bolus followed by a 12-hour infusion. This novel approach offers a safe strategy for same-day home discharge after uncomplicated coronary intervention.
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Affiliation(s)
- Olivier F Bertrand
- Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725 Chemin Ste Foy, Québec, Canada G1V 4G5.
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Dawkins KD, Gershlick T, de Belder M, Chauhan A, Venn G, Schofield P, Smith D, Watkins J, Gray HH. Percutaneous coronary intervention: recommendations for good practice and training. Heart 2006; 91 Suppl 6:vi1-27. [PMID: 16365340 PMCID: PMC1876395 DOI: 10.1136/hrt.2005.061457] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society. Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33,652 to 62,780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field. It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative.
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Affiliation(s)
- K D Dawkins
- British Cardiovascular Intervention Society, London, UK.
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Bertoni AG, Bonds DE, Thom T, Chen GJ, Goff DC. Acute coronary syndrome national statistics: challenges in definitions. Am Heart J 2005; 149:1055-61. [PMID: 15976788 DOI: 10.1016/j.ahj.2004.10.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing convergence in the management of acute myocardial infarction (AMI) and unstable angina (UA) has led some to consider whether these 2 diagnoses should be consolidated into acute coronary syndrome (ACS) for the purpose of coronary heart disease surveillance. METHODS We used the 1988-2001 Nationwide Inpatient Sample, which has demographic and diagnosis data on 6 to 7 million discharges per year from a sample of US nonfederal hospitals. We identified discharges with a first- or all-listed diagnosis of AMI ( International Classification of Diseases, Ninth Revision, Clinical Modification 410) or UA (International Classification of Diseases, Ninth Revision, Clinical Modification 411) and defined ACS-first as a primary diagnosis of either condition and all-listed ACS as codes 410 or 411 among any diagnoses. Sampling weights were applied to produce yearly national discharge estimates; annual population estimates were used to calculate yearly hospital discharge rates; rates were then adjusted to the 2000 standard population. RESULTS Rates of first- and all-listed AMIs changed little. Rates of first-listed UA fell 87% from 29.7/10,000 in 1988 to 3.9/10,000 in 2001. This sharp decline was seen among all age and sex groups. Consequently, rates of ACS as a primary diagnosis declined 44%. In contrast, discharge rates for all-listed UA and ACS declined only modestly. CONCLUSIONS As a primary diagnosis, UA is disappearing. Rates of first-listed ACS are quite sensitive to the decline in UA. Although discharge data based on first-listed diagnoses have been used to estimate the national incidence of AMI, they may not provide accurate data regarding current trends for ACS.
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Affiliation(s)
- Alain G Bertoni
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Klinke WP, Hilton JD, Warburton RN, Warburton WP, Tan RP. Comparison of treatment outcomes in patients > or =80 years undergoing transradial versus transfemoral coronary intervention. Am J Cardiol 2004; 93:1282-5. [PMID: 15135705 DOI: 10.1016/j.amjcard.2004.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Revised: 02/05/2004] [Accepted: 02/05/2004] [Indexed: 11/20/2022]
Abstract
We assessed the effect of transradial access (vs transfemoral access) for percutaneous coronary intervention on postprocedure length of stay and patient outcomes (in-hospital complications and all-cause and cardiac death at 6 and 12 months) in 225 elderly patients (> or =80 years old). Raw differences between transradial and transfemoral accesses were compared, and 3 forms of propensity score analysis were used to determine the true effect of transradial access. After matching to adjust for baseline differences in patient characteristics, remaining differences in outcomes and postprocedure length of stay were small and not statistically significant at the 95% level, but a decrease in postprocedural length of stay of nearly 1 day was observed and likely was not due to chance. Transradial access in patients > or =80 years old undergoing percutaneous coronary intervention should be preferred due to equivalent success rate and safety and likely reduction in postprocedural hospitalization.
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Affiliation(s)
- W Peter Klinke
- Victoria Heart Institute Foundation, University of Victoria, 315-1900 Richmond Avenue, Victoria, British Columbia V8R 4R2, Canada.
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