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Early sheath removal and ambulation in patients submitted to percutaneous coronary intervention: a randomised
Andrea Cornelia Augustin1, Alexandre Schaan de Quadros, Rogério E Sarmento-Leite
1Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
Insights
Immediate sheath removal after percutaneous coronary intervention (PCI) and early ambulation did not increase major vascular complications. This strategy also improved patient comfort, suggesting a safe alternative for selected patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Current post-percutaneous coronary intervention (PCI) care, particularly after femoral access, has seen limited innovation despite technical advancements.
- Earlier sheath removal and ambulation post-PCI could reduce healthcare costs and patient discomfort.
- The safety and efficacy of immediate sheath removal and early ambulation require further assessment.
Purpose of the Study:
- To evaluate the effectiveness and safety of a post-procedure strategy involving immediate arterial sheath removal and early ambulation.
- To compare major and minor vascular complication rates between immediate and delayed sheath removal protocols.
Main Methods:
- A randomized trial involving 347 patients undergoing PCI with a 6 French arterial sheath.
- Intervention group (n=172): immediate sheath removal, ambulation after 3 hours.
- Control group (n=175): sheath removal after 4 hours, followed by 6 hours of bed rest. Primary endpoint: major vascular complications (hematoma >10 cm, pseudoaneurysm, arterial bleeding).
Main Results:
- No statistically significant difference in major bleeding rates between groups (1.7% vs. 0.6%).
- Similar rates of other vascular complications and vasovagal reactions in both groups.
- Patients in the immediate sheath removal group reported significantly less pain (26% vs. 41%) compared to the control group.
Conclusions:
- Immediate arterial sheath removal with early ambulation after PCI is not significantly associated with increased major vascular complications.
- This strategy is linked to enhanced patient comfort, with reduced pain reported.
- While underpowered, the study suggests immediate sheath removal and early ambulation as a viable alternative for selected PCI patients.
Introduction:
Despite recent technical improvements and device developments, post-percutaneous coronary intervention care in patients submitted to this procedure performed through the femoral approach remains almost unchanged. An earlier sheath removal and ambulation could help to cut costs, save health system resources and prevent patient discomfort. However, this approach has not yet been well assessed.
Objectives:
The main objective of this paper was to evaluate a strategy of post-procedure immediate sheath removal and early ambulation.
Methods:
A randomised trial was conducted in 347 patients submitted to percutaneous coronary intervention that used a 6 French gauge arterial sheath. The intervention group (IG, n=172) had the arterial sheath removed immediately after the procedure and ambulated after 3 h of bed rest. The control group (CG, n=175) had the arterial sheath removed 4h after the end of the angioplasty and rested for an additional 6 h. The primary end point was the development of major vascular complications: hematoma>10 cm, pseudo-aneurism and arterial bleeding after or during ambulation. Secondary end points were minor vascular complications: hematoma<10 cm, vasovagal reactions after sheath removal, and assessment of patient's comfort during the peri-operative period.
Results:
Baseline characteristics did not differ statistically between groups, as major bleeding (IG=1.7% vs. CG=0.6%; p=0.31). Regarding other vascular complications and vasovagal reactions, there were also no significant differences. Patients of IG had less pain (26% vs. 41%, p=0.004) than CG, but the frequency of urinary retention was the same in both groups.
Conclusion:
This study, although underpowered, indicates that immediate arterial sheath removal with early ambulation after PCI was not significantly associated with an increase in major vascular complications and was associated with increased patient comfort. Although further studies with larger samples are necessary to confirm these results, this study suggests that immediate arterial sheath removal with early ambulation may be an alternative for selected elective patients submitted to percutaneous coronary interventions and for those with difficulties to endure prolonged bed rest.
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