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Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era
Christopher W Good1, James C Blankenship, Thomas D Scott
1Department of Cardiology, Geisinger Medical Center, Danville, PA 17822, USA.
Insights
Most percutaneous coronary interventions (PCI) can be safely performed same-day as diagnostic angiography. Staged PCI was linked to worse outcomes, suggesting ad hoc PCI is often preferable for better patient results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Ad hoc percutaneous coronary intervention (PCI) use varies geographically and institutionally.
- Factors influencing the adoption of the ad hoc PCI strategy remain unclear.
Purpose of the Study:
- To identify factors limiting the utilization of the ad hoc PCI strategy.
- To compare outcomes between ad hoc and staged PCI procedures.
Main Methods:
- Retrospective review of 580 PCI procedures in 2004, excluding emergent cases, transfers, and repeat procedures.
- Defined "ad hoc" PCI as same-day as diagnostic angiography; "staged" as performed on a different day.
- Used logistic regression to analyze correlates of ad hoc PCI, success, and complications.
Main Results:
- 96% of eligible PCIs were ad hoc (557/580), with only 4% staged (23/580).
- Staged PCI patients had more lesions, higher rates of no-reflow and myocardial infarction, and increased contrast/fluoroscopy use.
- History of heart failure, renal insufficiency, recent myocardial infarction, and prior bypass surgery were associated with staged PCI and/or lower PCI success.
Conclusions:
- The majority of PCI procedures can be safely and effectively performed on the same day as diagnostic angiography.
- Ad hoc PCI appears to be a safe and effective strategy, potentially associated with better outcomes than staged procedures in eligible patients.
Background:
The frequency of ad hoc percutaneous coronary intervention (PCI) varies among institutions and regions of the country. It is unclear what factors limit use of the ad hoc strategy.
Objective:
To define factors which limit the use of the ad hoc strategy.
Methods:
All patients who underwent PCI at our center in 2004 were reviewed. Patients who had emergent PCI for ST-elevation myocardial infarction (n = 188), those who had undergone diagnostic coronary angiography at a referring facility (n = 54), and those who had a repeat PCI after a previous ad hoc PCI (n = 19) were excluded. PCIs performed the same day as diagnostic angiography were considered "ad hoc"; all others were designated "staged". Demographic and procedural factors through hospital discharge were prospectively recorded. Logistic regression analysis was performed to identify correlates of ad hoc PCI, PCI success, and PCI complications.
Results:
Of the 580 PCI procedures eligible for analysis, 557 (96%) were ad hoc and 23 (4%) were staged. Patients undergoing staged PCI had more lesions treated, a higher rate of no-reflow and periprocedural myocardial infarction, and higher contrast volumes and fluoroscopic times. Logistic regression analysis revealed that patients with history of heart failure, renal insufficiency and a recent myocardial infarction were more likely to undergo a staged PCI. Patients undergoing a staged PCI and those who had previous bypass surgery were more likely to have an unsuccessful PCI procedure.
Conclusion:
Most PCI procedures can be performed safely and effectively on the same day as diagnostic coronary angiography.
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