Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study

Small, A.; Klinke, Peter; Siega, Anthony Della; Fretz, Eric; Kinloch, David; Mildenberger, Richard R.; Williams, M. B.; Hilton, David

doi:10.1002/ccd.21277

Cited by 66 publications

(34 citation statements)

References 11 publications

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“…While OPD TRI has been shown to be feasible and safe in Western studies, [5][6][7][11][12][13][14][15][16][17][18] the situation in Asia is unclear. The present prospective nonrandomized comparison study involving acceptably large numbers of patients provides an indication that, by careful selection criteria, same-day discharge after OPD TRIs is acceptable and without serious PCI related complications.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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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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Section: Discussionmentioning

confidence: 99%

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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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“…Two published meta analyses have previously described at least equivalent revascularisation results using either approach with radial access having significant lower bleeding complications whilst at the cost of higher technical failure rates [8,9]. In a series of over 1000 transradial PCI's, Small et al [10] confirmed that all post procedure complications could be and were identified within six hours of the procedure with complications between six and 24 hours being exceedingly rare. Despite this published data there has remained a general reluctance to discharging patients on the day of the procedure.…”

Section: Introductionmentioning

confidence: 87%

Safety of same day discharge following percutaneous coronary intervention

Herman

2011

Heart, Lung and Circulation

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“…This clearly impacts the patient's length of hospital stay, thus increasing occupied bed days, and health care expenditure [23]. …”

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Outpatient (Same-day care) Neuroangiography and Neurointervention

et al. 2012

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PurposeThere have been few reports regarding same-day discharge following uncomplicated procedures such as cerebral angiography and neurointervention. We present same-day experience with cerebral angiography and neurointervention during the past three years.Materials and MethodsFour hundred and fifty-three patients underwent cerebral angiography or neurointervention at Asan Medical Center between January 2009 and December 2011. Of these patients, 249 (55%) underwent diagnostic catheter cerebral angiography and 204 patients (45%) underwent neurointerventional procedures as same-day procedures. We analyzed any complications, the modified patient-care process, the yearly trend in patient increases, disease categories, and the additional duration of admission for these procedures.ResultsThe number of overall patients increased by an average of 51% annually. The disease categories included aneurysm (51%), atherosclerosis (11%) and arteriovenous malformation (10%), etc. for which the patient underwent angiography, and aneurysm (42%), venous malformation (28%), and arteriovenous malformation (17%), etc. for which patients underwent neurointervention. Same-day care patients were admitted to the intermediary care unit in the angiosuite. Neurointervention patients were sent to the neurology intensive unit after the procedure. The same-day care patients stayed in angiosuite for six hours following the transfemoral procedure. The mean admission duration for neurointervention was 2.4 days. There were no reported complications for the same-day care procedures.ConclusionOur study revealed an increasing tendency toward same-day care for patients who require angiography and neurointervention. Further studies will be required to better define the cost-minimization effects of outpatient practice as well as the patient perception of this fast-tracking method. We propose that outpatient angiography and neurointervention will undoubtedly continue to increase over the next decade.

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Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study

Cited by 66 publications

References 11 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

Safety of same day discharge following percutaneous coronary intervention

Outpatient (Same-day care) Neuroangiography and Neurointervention

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