In-hospital monitoring after coronary angioplasty

At the University Hospital of Geneva there are three postcoronary angioplasty monitoring levels: (A) intensive care unit; (B) optional ECG monitoring (cardiology unit); and (C) no monitoring (other unit). To assess the adequacy of patient monitoring after coronary angioplasty, we studied the clinical outcome of 200 consecutive patients undergoing coronary angioplasty at different monitoring levels. Thirty-nine patients (20%) were in level A. Their outcome was 1 death, 1 emergency bypass operation, and 7 acute myocardial infarcts. Ninety-six patients (48%) were in level B: no major complication, no transfer of monitoring level, and mean hospital stay 2.7 +/- 1.3 days. Sixty-five patients (32%) were in level C: 1 death, 2 elective bypass operations, 6 transfers to level A, and mean hospital stay 5.9 +/- 4.6 days. Electrocardiogram monitoring of 135 patients yielded 23 significant findings (17%), 22 of which occurred in patients with complicated or failed procedure. In the 122 patients with successful coronary angioplasty without angiographic visible local complications and without clinical symptoms at the end of the procedure, no significant arrhythmia or acute myocardial infarction was documented. For this type of patient, ECG monitoring is not a prerequisite after coronary angioplasty. Surveying all patients after coronary angioplasty in the coronary care unit would not significantly reduce complications. Aftercare in a cardiology unit results in a shorter hospital stay.