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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Ad hoc percutaneous coronary intervention: a consensus statement from the Society for Cardiovascular Angiography and

James C Blankenship1, Osvaldo S Gigliotti, Dmitriy N Feldman

  • 1Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA. jblankenship@geisinger.edu

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 1, 2012
PubMed

Insights

Ad hoc percutaneous coronary interventions (PCI) performed during the same session as diagnostic catheterization offer convenience and cost-efficiency. While generally safe and effective, delayed PCI may be preferable in specific patient subsets for optimal outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Percutaneous coronary interventions (PCI) can be done immediately (ad hoc PCI) or later (delayed PCI) after diagnostic catheterization.
  • Ad hoc PCI is increasingly common, especially for acute coronary syndromes, but its use in stable ischemic heart disease is debated.
  • Existing cohort studies show no consistent differences in safety or efficacy between ad hoc and delayed PCI.

Purpose of the Study:

  • To review patient subsets and clinical situations where ad hoc PCI or delayed PCI is preferable.
  • To analyze the appropriateness of ad hoc PCI for stable ischemic heart disease.
  • To discuss patient and payer perspectives on ad hoc PCI.

Main Methods:

  • Review of existing randomized trials and cohort studies comparing ad hoc PCI and delayed PCI.
  • Analysis of clinical evidence regarding the safety and efficacy of both strategies.
  • Identification of specific patient groups and clinical scenarios favoring one strategy over the other.

Main Results:

  • The majority of data indicate equivalent outcomes between ad hoc and delayed PCI.
  • Patient preference for convenience and payer preference for cost-efficiency favor ad hoc PCI.
  • Certain clinical situations and patient subsets may benefit more from delayed PCI.

Conclusions:

  • Ad hoc PCI is a convenient and cost-efficient strategy with generally equivalent outcomes to delayed PCI.
  • Careful preprocedural planning and reassessment are crucial for appropriate ad hoc PCI in stable ischemic heart disease.
  • Delayed PCI may be safer or yield better outcomes in specific clinical contexts, necessitating individualized treatment decisions.

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