Original title: Assessment of Clinical Outcomes related to Early Discharge alter elective Percutaneous Coronary Intervention: COED PCI Reference: Purushothaman Muthusamy MD, et al. Catheterization and Cardiovascular Intervention 81:6-13 (2013)
The standard procedure in most institutions is that after angioplasty (PTCA) patients are discharged the next morning. There are some reports in which they were ambulatory but the safety of this has not been well established.
The aim of this study was to analyze the results of patients who underwent PTCA and were granted discharge on the same day. We analyzed 200 consecutive patients admitted for PTCA scheduled from December 2008 to June 2011 in only one hospital. Follow-up was conducted by telephone within 24 hours and after 7 days by trained nurses.
We evaluated vascular complications, readmissions, symptoms and MACE (combination of death, myocardial infarction, urgent revascularization and pulmonary embolism). All patients received pretreatment with aspirin and clopidogrel or prasugrel. The access was femoral in 75.5% of patients with 60% utilization of a percutaneous closure device. The access was radial for the remaining 24.5%.
Patients with femoral access stay at rest for 2-3 hours if CPB was used and 4-6 hours if it was manual compression. Ambulation time after the procedure was 4.5 ± 1.9 hours for the femoral access and 3.9 ± 1.3 hours for radial access. There was no major bleeding or MACE at 24 hours or 7 days. Minor bleeding was present in 8 patients (4%), 6 of them had femoral access. Readmission within 24 hours was 1.5%, (one patient for non-cardiac chest pain and edema in the access site).
Within 7 days another 3 patients were readmitted (1.5%), one has pericarditis, one for non-cardiac chest pain and one having psuedoaneurisma that was resolved using a thrombin injection.
Conclusion
Identifying angioplasty low risk patients, performing the procedure and subsequent discharge on the same day was safe with a low rate of short-term complications.
Editorial Comment:
Although this is a non-randomized study and not controlled, results are encouraging and allow lower costs and increased hospital bed availability. Hospitalization costs can be further reduced by increasing the percentage of radial access and thereby saving on percutaneous closure devices. More research is needed in this area in order to make this behavior used more often.
Thanks to Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.
Dr. Carlos Fava para SOLACI.ORG