background: Percutaneous coronary intervention (PCI) has become one of the most commonly performed cardiac procedures in clinical practice. Due to improvement in outcomes, reduced acute complication rates, the need to reduce costs and the limited availability of hospital beds, elective PCI with same-day discharge has become an interesting option. Methods: Singlecenter registry with a retrospective evaluation of all patients undergoing elective PCI who were discharged on the same day, from January 2009 to March 2012. The rates of major adverse cardiac events (death, myocardial infarction, target-vessel revascularization and stroke), in addition to stent thrombosis, vascular complications and re-hospitalization between hospital discharge and the first 30 days of follow-up were determined. results: Sixty-nine patients were evaluated with mean age of 64.5 ± 11.2 years, most of them were male (82%), and 28% were diabetics. All patients had stable coronary artery disease and type A or B1 lesions (36% and 36% respectively). Radial access was the most commonly used approach (89%), with 5 F introducer sheaths in 56% and 6 F in the remaining patients. Procedure success was obtained in 98.5%. No clinical events were observed at the 30-day follow-up. Conclusions: Our results demonstrated that same-day discharge was safe for patients with low clinical and angiographic risk undergoing elective PCI with no procedurerelated complications.
Objective In the clinical scenario of ST-segment elevation acute myocardial infarction,
several patients with multivessel coronary atherosclerotic disease are discharged
without a defined strategy to monitor the residual atherosclerotic lesions. The
clinical endpoints evaluated were cardiovascular death, symptoms of angina
pectoris, rehospitalization for a new acute coronary syndrome, and the necessity
of reintervention during the two-year follow-up. MethodsThis observational, prospective, and historical study included multivessel
coronary atherosclerotic disease patients who were admitted to a tertiary care
university hospital with ST-segment elevation acute myocardial infarction and
underwent primary percutaneous coronary intervention with stent implantation only
at the culprit lesion site; these patients were monitored in the outpatient clinic
according to two treatments: the Clinical Group - CG (optimized pharmacological
therapy associated with counseling for a healthy diet and cardiac rehabilitation)
or the Intervention Group - IG (new staged percutaneous coronary intervention or
surgical coronary artery bypass graft surgery combined with the previously
prescribed treatment). Results Of 143 patients consecutively admitted with ST-segment elevation acute myocardial
infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the
clinical endpoints, the cardiovascular death rate did not differ between the CG
and IG. The symptom of angina pectoris and the rehospitalization rate for a new
episode of acute coronary syndrome were accentuated in the CG
(P=0.020 and P=0.049, respectively) mainly in
individuals with evidence of ischemia evidenced by myocardial scintigraphy
(P<0.001 and P=0.001, respectively) which
culminated in an even greater need for reintervention (P=0.001)
in this subgroup of patients. Conclusion The staged intervention was demonstrated to be safe and able to reduce angina
pectoris and rehospitalization for a new episode of acute coronary syndrome. In
addition, it decreases the likelihood of unplanned reinterventions of patients
without ischemia evidenced by myocardial scintigraphy.
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