Original title: Ambulatory Transradial Percutaneous Coronary Intervention: A Safe, Effective, and Cost-Saving Strategy. Reference: Philippe Le Corvoisier et al. Catheterization and Cardiovascular Interventions 81:15–23 (2013).
The number of PCI procedures has increased and for many interventional cardiology centers PC interventions entail significant resource consumption. Reducing post procedure hospital stay could reduce costs and optimize hospitalization resources.
The safety of post PCI discharge the same day of procedure should be established before incorporation to daily practice. The aim of this prospective multicenter study was to determine the safety, cost and acceptance of patients undergoing ambulatory transradial PCI. The study took place in 3 high volume centers in France; it assessed 370 consecutive patients with stable angina or silent ischemia for coronary catheterization followed by PCI and same day discharge. From 370 patients, 220 were selected for 4-6 hr observation and discharge.
Inclusion criteria were:
•+18 years
•Stable angina or silent ischemia
Exclusion criteria:
•Clinical criteria
ACS, Symptomatic cardiac insufficiency and/or <35% ejection fraction, Severe chronic kidney disease (creatinine clearance
•Social criteria
Doubts on patient acceptance, Place of residence farther than 1 hour from hospital, Inadequate home care.
•PCI related criteria
Approach other than radial, Use of Glycoprotein IIb/IIIa inhibitors, < 3 post interventional TIMI flow , > 1 mm branch occlusion, Persistent chest pain, Hemodynamic instability during procedure, Ventricular arrhythmia during procedure, Procedure completed after 2 pm.
From the 220 patients, 213 (96.8%) were discharged after a 4-6 hr observation period. 4 patients remained hospitalized (1.8%) for cardiovascular reasons and 3 patients (1.4%) for non cardiovascular reasons. At one month follow up, one patient presented a non fatal infarction at day 4 for stent thrombosis and 3 patients were readmitted for atypical chest pain, without ECG changes or troponin elevation. 87% of patients were satisfied with ambulatory management and 96% were open to repeat the experience.
Conclusion
Ambulatory PCI in stable patients is safe, feasible and well accepted by patients. It’s a promising strategy to lower costs and optimize healthcare resources.
Editorial Comment:
As an observational study, it fails to identify prediction factors; however, the study provides evidence in support of ambulatory PCI as daily practice: it included a significant number of patients with multiple vessels, bifurcations and recanalizations, due to the fact that all PCI procedures were ad hoc, which has external value and easily proves feasibility. Perhaps we could start including the least complex procedures and gain experience to include all procedures, as the present study did.
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