Reasons for repeat urgent cardiac procedures within the same day
Sukhdeep Bhogal1, Mohil Garg2, Namratha S Meda2
1Section of Interventional Cardiology, Sovah Health, Martinsville, Virginia, USA.
Insights
Few patients require same-day repeat cardiac catheterization procedures. Vascular complications and repeat percutaneous coronary intervention (PCI) are primary reasons, highlighting the need for careful vascular access management and post-procedure chest pain assessment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Patient Safety
Background:
- Technological advancements aim to minimize same-day repeat procedures in cardiac catheterization labs.
- Understanding reasons for repeat procedures is crucial for improving patient outcomes.
Purpose of the Study:
- To identify and analyze the reasons for patients returning for urgent repeat procedures in the cardiac catheterization laboratory on the same day.
- To inform strategies for reducing same-day repeat cardiac procedures.
Main Methods:
- Retrospective review of patients undergoing cardiac catheterization procedures between November 2013 and January 2022.
- Exclusion of patients transferred from outside centers.
- Identification of indications for both initial and repeat procedures.
Main Results:
- Out of 55,942 procedures, 140 required same-day repeat interventions.
- Vascular complications (24.2%) and repeat percutaneous coronary intervention (PCI) (20.7%) were the most frequent reasons for repeat procedures.
- Acute limb ischemia and pseudoaneurysm were common vascular complications.
Conclusions:
- Same-day repeat cardiac catheterization procedures are infrequent.
- Vascular access management and post-procedure chest pain evaluation are critical areas for attention to prevent same-day repeat procedures.
Background:
With advances in technology and technique, the expectations are that patients undergoing procedures in the cardiac catheterization laboratory will not need to return for a repeat procedure within the same day.
Objectives:
Report why subjects undergoing cardiac procedures return urgently to the catheterization laboratory for a repeat procedure during the same day.
Methods:
We retrospectively reviewed patients who were brought back to the cardiac catheterization laboratory within the same day for a repeat procedure. The reasons for index and repeat procedure were identified. Patients who were transferred from an outside center after an initial procedure at other centers were excluded.
Results:
Between November 2013 and January 2022, 55,942 catheterization procedures were performed at our institution, of which 140 entries were included in our analysis. Common reasons for the index procedure were diagnostic angiography (35.0%), percutaneous coronary intervention (PCI, 29.2%), and transcatheter aortic valve replacement (15.0%). The most common reason for bringing these patients back to the cardiac catheterization laboratory within the same day was vascular complications (24.2%), followed by repeat PCI (20.7%), need for hemodynamic support (15.0%), heart team discussion and PCI (10%), and pacemaker implantation (10%). Acute limb ischemia was the most commonly identified vascular complication (7.1%), followed by pseudoaneurysm (5%).
Conclusion:
Our study demonstrates that a very small number of patients underwent repeat procedures within the same day. Special attention should be paid to vascular access and closure and assessment of recurrent chest pain postprocedure, as these are the main reasons for same-day repeat procedures.
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