Same-Day Angioplasty and Diagnostic Catheterization: Safe and Effective but Riskier in Unstable Angina

Abstract

Percutaneous transluminal coronary angioplasty was performed at the time of the diagnostic catheterization in 188 patients (215 lesions) at a University Hospital in order to assess the efficacy of this approach and the potential role it should play in the evaluation and treatment of patients. Patients either presented for diagnostic catheterization for evaluation of stable coronary disease (79 patients) or for unstable or new onset anginal symptoms (109 patients). Lesions were graded as to whether they were simple or complex; and post angioplasty films were reviewed for success rate, and degree of revascularization. Patients who were referred for stable anginal symptoms had a slightly higher success rate (91%) compared to those who were referred for new onset or more unstable symptomatology (85%, p = ns). Additionally, lesions morphology was judged to be more complex in unstable patients, as 67% had complex lesions with the presence of thrombus or ulcerated plaque in 56% of these stenoses. Angioplasty success was high for simple lesions in all patients, but was most unfavorable for complex stenoses in patients who presented with unstable symptoms (81% success rate). In patients who presented with new onset or unstable symptoms multivessel disease was present in 69% and angioplasty was more often geared at dilating a culprit stenosis leaving only 49% of these patients with complete revascularization. On the other hand, in 76% of those patients who presented with stable angina complete revascularization was a common outcome. Length of hospital stay was considerably shorter at 2.9 +/- 0.8 days in those patients who presented with stable symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

“…Accordingly, patients with unstable or progressive symptoms of myocardial ischemia are appropriate candidates for ad hoc PCI. Although earlier studies suggested complications were higher in unstable patients treated by the ad hoc strategy [5,9], more recent data suggest that rapid triage of unstable patients to the catheterization laboratory with aggressive antithrombotic therapy followed by ad hoc PCI results in superior 30-day outcomes compared to prolonged antithrombotic treatment for 3-5 days before angiography [20].…”

“…Nine studies examined ad hoc balloon angioplasty before stenting became the dominant procedure [1][2][3][4][5][6][7][8][9]. Among these studies, 12-83% of the PCIs were classified as ad hoc.…”

“…Studies that compared outcomes of separate PCI to outcomes of ad hoc PCI found no significant differences in angiographic success rates or complications (Table I) [2-4,6 -9]. In two studies, ad hoc procedures were associated with an increased risk of complications in patients with unstable angina or other high-risk features [5,9]. Among the nine studies there was agreement that ad hoc PCI, as performed in these centers and on selected patients, was safe.…”

“…As percutaneous coronary intervention (PCI) has become safer and easier to accomplish, it is now often performed at the time of diagnostic coronary angiography [1][2][3][4][5][6][7][8][9]. The forces behind this trend include convenience for the patient, efficiency for the physician, and possibly cost savings for payers.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…During the past several years, in an effort to reduce hospital length of stay and potentially reduce costs, PCI has increasingly been performed immediately after the diagnostic coronary angiographic procedure (811), with reported incidence ranging from 52% to 83% (812)(813)(814). The indications for diagnostic catheterization and coronary angiography in different catheterization laboratory settings are discussed in the ACC/SCAI Expert Consensus Document on Catheterization Laboratory Standards (Table 28) (309,815).…”