Safe and feasible immediate retransfer of patients to the referring hospital after acute coronary angiography and percutaneous coronary angioplasty for patients with acute coronary syndrome

Abstract

Background: The challenge with fast track (FT) is to avoid compromising medical safety. We aimed to investigate whether patients with acute coronary syndrome could be safely retransferred to the referral hospital on the same day after coronary angiography and/or percutaneous coronary angioplasty (PCI). Methods and results: A total of 399 consecutive patients were prospectively randomized: 206 to ordinary care (OC) and 193 to the FT group. Of these, 30% of patients were admitted for unstable angina pectoris and 70% for non-STsegment elevation myocardial infarction. The FT patients were evaluated for possible same-day return after angiography and/or PCI. Crossover, acute, and 30-day major events were recorded. The radial approach was used in 91 and 87% in the OC and FT group, respectively. Of the FT patients, 95% were returned on the same day and nine crossover patients (4.7%) the next day or later. Major events occurred in nine patients (2.2%); five in the OC and four in the FT group. There were a total of five events within 24 hours. No events were observed during transportation and there were no early retransfers. Conclusions: Immediate written reports and good communication with the referring hospital enabled thoroughly selected patients to be safely returned on the same day as angiography and/or PCI.

Safety of Back‐Transfer to Local Hospitals During an Acute Care Hospitalization

“…One of the more concerning results of this report is the higher apparent mortality in back‐transferred patients, a finding that holds even when compared with PS‐matched controls. This contradicts prior data on back‐transfer in cardiology and neonatology patients …”

“…This contradicts prior data on back-transfer in cardiology and neonatology patients. [10][11][12][13][14][15] The causality of these findings is unknown. Are the patients identified as more likely to die or need more prolonged hospitalization, and thus are back-transferred to complete their care closer to home?…”

“…In Europe, backtransfer is used for patients undergoing routine coronary angiography and percutaneous coronary intervention (PCI). [10][11][12][13] This practice was found to be safe and feasible with regard to re-admission, mortality, and other complications. 13 In the United States, back-transfer has been shown to be safe for stable neonates after a hospitalization at a tertiary care neonatal intensive care unit.…”

“…The safety of back‐transfer has only been examined for limited populations. In Europe, back‐transfer is used for patients undergoing routine coronary angiography and percutaneous coronary intervention (PCI) . This practice was found to be safe and feasible with regard to re‐admission, mortality, and other complications .…”

Early discharge compared with ordinary discharge after percutaneous coronary intervention – a systematic review and meta-analysis of safety and cost

“…Two additional articles with an assessment of cost were based on studies already included in the safety analysis, and we added these to our cost analyses 8,9. Andersen et al16 originally included 399 patients in their study. In the meta-analysis of safety, we have considered only the 167 who had PCI during their index stay.…”