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Safety of same-day-discharge radial percutaneous coronary intervention: a retrospective study
A A Ziakas1, B P Klinke, C R Mildenberger
1Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Insights
Same-day discharge radial percutaneous coronary intervention (PCI) is safe for select patients. This study found no major access site complications, with low rates of minor issues and subacute vessel closure within 24 hours.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The safety and feasibility of same-day discharge percutaneous coronary intervention (PCI) remain debated.
- Radial access PCI has gained popularity, but same-day discharge protocols require further evaluation.
Purpose of the Study:
- To assess the safety and feasibility of same-day discharge following radial PCI.
- To evaluate the incidence of access site complications and repeat procedures within 24 hours and 1 month post-discharge.
Main Methods:
- A retrospective analysis of 943 patients undergoing same-day discharge radial PCI.
- Patients were contacted post-procedure to report entry site complications, repeat angiograms, or repeat PCI.
Main Results:
- No major access site complications or hospital admissions were reported.
- Minor entry site complications occurred in 2.8% within 24 hours and 4.0% within 1 month.
- Chest pain was reported by 2% within 24 hours and 11.5% within 1 month; 0.1% required repeat angiography within 24 hours.
- Six patients (0.6%) experienced subacute vessel closure within 1 month, with none in the first 24 hours.
Conclusions:
- Same-day discharge radial PCI is a safe and feasible strategy for carefully selected low-risk patients.
- Major access site complications are rare, and subacute vessel closure rates are low and primarily occur beyond the immediate post-discharge period.
Background:
The safety and feasibility of same-day discharge percutaneous coronary intervention (PCI) is still controversial.
Methods:
Patients (n = 943) had same-day discharge radial PCI between April 1998 and March 2001 in our hospital. Patients were contacted and asked whether they had entry site complications or a repeat angiogram and/or PCI within 24 hours and 1 month after the procedure.
Results:
At the time the study was conducted, 811 patients responded, 38 patients had died, and 94 were alive but refused to participate or it was impossible to contact them; 27 patients (2.8%) visited their doctor and/or the hospital within 24 hours after discharge because of entry site complications, and 38 patients (4.0%) visited within 1 month. However, none of the patients had major access site complications or needed to be admitted to the hospital. Within 24 hours from discharge 17 patients (2%) reported chest pain, and only 1 (0.1%) required a repeat angiogram, which did not show target vessel occlusion. During the first month, 94 patients (11.5%) reported chest pain, 11 (1.3%) underwent a repeat angiogram, out of which 4 had subacute vessel closure; 2 of the 132 patients that we could not contact had subacute stent thrombosis within 1 month and died.
Conclusions:
None of the patients having same-day discharge radial PCI had major access site complications. Six patients (0.6%) had subacute vessel closure, but none had this during the first 24 hours after discharge. Same-day discharge radial PCI in certain low-risk patients is a safe and feasible strategy.
