Day case transradial coronary angioplasty: A four-year single-center experience

Wiper, Andrew; Kumar, Sanjiv; MacDonald, John Emyr; Roberts, David H.

doi:10.1002/ccd.20743

Cited by 47 publications

(27 citation statements)

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“…4) Accordingly, TRI has been increasingly adopted for out-patient department (OPD) procedures, with same-day discharge, with a variety of studies including randomized trials verifying the safety and feasibility of the approach in Western countries. [5][6][7][12][13][14][15][16][17][18][19][20] Beginning in 1994, we and others introduced TRI in Asia. [8][9][10] However, feasibility and safety issues of OPD TRI without admission have not been reported in Asia.…”

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confidence: 99%

Transradial Approach Percutaneous Coronary Interventions in an Out-Patient Clinic Safety and Feasibility Trial of Same-Day Discharge Versus Hospital Admission

et al. 2010

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SummarySame-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. (Int Heart J 2010; 51: 371-376) Key words: Angioplasty, Out-patient, Transradial T he transradial (TR) approach for diagnostic coronary angiography was first reported in 1989, 1) and the use of TR percutaneous coronary intervention (PCI) was reported in 1992.2) The benefits of TR intervention (TRI) include less bleeding complications, 3) and earlier ambulation and better quality of care after the procedure. 4) Accordingly, TRI has been increasingly adopted for out-patient department (OPD) procedures, with same-day discharge, with a variety of studies including randomized trials verifying the safety and feasibility of the approach in Western countries. [5][6][7][12][13][14][15][16][17][18][19][20] Beginning in 1994, we and others introduced TRI in Asia. [8][9][10] However, feasibility and safety issues of OPD TRI without admission have not been reported in Asia. The present study was undertaken to explore the safety and feasibility of OPD patients with indications for TR coronary angiography and ad hoc PCIs, who fulfilled predefined criteria for same-day discharge after TRI. Consecutive patients after OPD TRIs were selected by operators and were divided into two groups (admission for close observation or without admission), and the clinical outcomes of the two groups were compared prospectively.

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Transradial Approach Percutaneous Coronary Interventions in an Out-Patient Clinic Safety and Feasibility Trial of Same-Day Discharge Versus Hospital Admission

et al. 2010

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“…Indivíduos que se submeteram a procedimentos invasivos coronarianos pelas vias clássica ou radial expressam nítida preferência pela última abordagem 5 . Ademais, a possibilidade da realização de intervenção coronariana percutânea ambulatorial pode reduzir os custos e a extensão do período de hospitalização [14][15][16] .…”

Section: Discussionunclassified

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

Labrunie¹,

Tebet²,

Andrade³

et al. 2009

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O acesso transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. Método: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clás-sica. Resultados: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). Conclusão: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes. DESCRITORES: Artéria radial. Angiografia coronária. Aprendizagem. ABSTRACT Transradial Coronary Angiography: Learning Curve, Evaluated by a Multicenter StudyBackground: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. Methods: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. Results: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical technique group. The number of catheters used, the duration of the procedure and X-ray exposure were greater in the tr...

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“…31 In the UK up to 75% of all elective operations are now performed as dayonly cases 32 compared with current Australian rates of 50%. Increasingly, operations such as laparoscopic cholecystectomy 33 and percutaneous coronary angioplasty 34 can be performed as day-only cases. 3.…”

Section: Functionally Separating Acute and Elective Beds And Servicesmentioning

confidence: 99%

Public hospital bed crisis: too few or too misused?

Scott¹

2010

Aust. Health Review

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*Increasing demand on public hospital beds has led to what many see as a hospital bed crisis requiring substantial increases in bed numbers. By 2050, if current bed use trends persist and as the numbers of frail older patients rise exponentially, a 62% increase in hospital beds will be required to meet expected demand, at a cost almost equal to the entire current Australian healthcare budget. *This article provides an overview of the effectiveness of different strategies for reducing hospital demand that may be viewed as primarily (although not exclusively) targeting the hospital sector -increasing capacity and throughput and reducing readmissions -or the non-hospital sector -facilitating early discharge or reducing presentations and admissions to hospital. Evidence of effectiveness was retrieved from a literature search of randomised trials and observational studies using broad search terms. *The principal findings were as follows: (1) within the hospital sector, throughput could be substantially improved by outsourcing public hospital clinical services to the private sector, undertaking whole-of-hospital reform of care processes and patient flow that address both access and exit block, separating acute from elective beds and services, increasing rates of day-only or short stay admissions, and curtailing ineffective or marginally effective clinical interventions; (2) in regards to the non-hospital sector, potentially the biggest gains in reducing hospital demand will come from improved access to residential care, rehabilitation services, and domiciliary support as patients awaiting such services currently account for 70% of acute hospital bed-days. More widespread use of acute care and advance care planning within residential care facilities and population-based chronic disease management programs can also assist. *This overview concludes that, in reducing hospital bed demand, clinical process redesign within hospitals and capacity enhancement of non-hospital care services and chronic disease management programs are effective strategies that should be considered before investing heavily in creating additional hospital beds devoid of any critical reappraisal of current models of care. What is known about the topic?There is a growing demand for inpatient care in Australia, with presentations to public hospital emergency departments increasing by 4.9% per year over the last 5 years and admission numbers increasing by 3.6% per year. Increasing numbers of hospital beds may give only short-term reprieve in lowering bed occupancy rates if little attention is giving to improving hospital efficiency by internal process redesign or by decreasing demand for acute hospital beds by improving capacity of the non-hospital sector to manage sub-acute illness and chronic disease. What does this paper add? This article provides a narrative meta-review of the evidence of effectiveness of various reform strategies. The key findings are that, within the hospital sector, patient throughput could be substantially improved by:...

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Day case transradial coronary angioplasty: A four-year single-center experience

Cited by 47 publications

References 20 publications

Transradial Approach Percutaneous Coronary Interventions in an Out-Patient Clinic Safety and Feasibility Trial of Same-Day Discharge Versus Hospital Admission

Transradial Approach Percutaneous Coronary Interventions in an Out-Patient Clinic Safety and Feasibility Trial of Same-Day Discharge Versus Hospital Admission

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

Public hospital bed crisis: too few or too misused?

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