Author + information
- Juan Manuel Telayna Jr.,
- Eduardo Noé Ortuño Campos,
- Ricardo Andrés Costantini and
- Telayna Juan Manuel
In 2009 the Society for Cardiac Andiography and Interventions (SCAI) defines the lenght of stay (LOS) after coronary angioplasty (PCI), and which could be discharged the same day. Today, same day discharge PCI remains a discussion topic and we don't know clearly whether these criteria could be reconsidered and extended to a higher risk population.
Evaluate clinical and procedure results of patients (pts) in our formal same day discharge (SDD) PCI program, whether meeting or not the SCAI criteria.
In September 2009 we started a formal program of SDD PCI. Until November 2015, 1696 PCI were performed, 867 (51%) of whom where elective. Of them, 232 (27%) met our criteria for SDD PCI. Those patients meeting SCAI criteria for SDD comformed group A (n=54; 23%). Patients not meeting SCAI criteria conformed group B (n=178; 67%). These group also achieved our SDD program standards (inclusion: unstable angina with negative biomarkers; PCI with stent regardless of length or treated vessels; radial access; procedure ended before 4 pm; EF ≥ 30%; 4 hr monitoring post PCI. Exclusion: treatment of only patent vessel; unprotected left main; CPR; suboptimal result; persistent angina post PCI; major vascular access complication).
We evaluated the following cardiovascular and vascular access events within 24 hours after PCI: cardiovascular death, urgent CABG, myocardial infarction, re intervention, pseudoaneurysm, major bleeding, AV fistula, symptomatic radial artery occlusion).
Baseline characteristics in Group A vs Group B n (%) respectively: Age 61±9 vs 61±4; male 47(87) vs 162(91); CKD 0 vs 3(2); PAD 0 vs 9(5)p=0.09; COPD 0 vs 6(3); impaired left ventricular function 0 vs 24(13) p=0.004; stable angina 13(24) vs 27(15); silent ischemia 41(76) vs 88(49) p=0.001; unstable angina 0 vs 63(35) p=0.001; single vessel treated 45(83) vs 86(48) p=0.001; multivessel treatment 0 vs 58(33) p=0.001; 6 Fr 52(96) vs 167(94); 8 Fr 2(4) vs 5(3); at least one DES 38(70) vs 152(85) p=0.01; length of stent ≥ 28 mm 0 vs 134(75) p=0.001.
Group A vs Group B n (%) respectively: technical success 54(100) vs 178(100). There were no in hospital deaths, early coronary occlusion or major vacular complicationes in any of the groups. There were no extra hospital deaths during follow up (average 23±19 vs 25±20). Re intervention rates were 5(9) vs 8(4).
The clinical and procedure outcomes were similar for both groups. Our results are promising to go beyond the recommendations suggested by the SCAI. A more robust study to confirm these findings will be necessary.