Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study.
OBJECTIVE
To assess the timeframe of postprocedural complications following transradial percutaneous intervention in selected nonlow-risk risk patients as a feasibility study for same day discharge.


BACKGROUND
Percutaneous coronary intervention (PCI) is traditionally performed as an inpatient procedure. Transradial access with its lower complication rate facilitates safe and same day discharge. We hypothesize that with current standards of pharmacotherapy and intervention, complications post transradial percutaneous coronary angioplasty even in a nonlow-risk patient cohort will be evident within 6 hr or occur more than 24 hr post procedure. Under these circumstances, overnight stay results in no improvement in patient safety.


METHODS
2,189 patients underwent transradial PCI at our institution between January 2005 and June 2006. Of these 1,174 were assessed as intermediate or high risk and admitted postprocedure. The remaining 1,015 were assessed as low risk and discharged the day of procedure. All 1,174 inpatients were entered into our study database. Information was collected on patient demographics, angiographic characteristics, post procedural complications, and timing of post procedural events.


RESULTS
1,543 ACC type B2 or C lesions were treated in 1,174 patients. All post-procedural complications were identified within 6 hr of the intervention or occurred more than 24 hr later when patients would have been discharged according to overnight admission protocols.


CONCLUSIONS
Day case transradial percutaneous intervention with a 6-hr period of post procedure observation is a safe and feasible practice. The presence of higher-risk features should not be considered an absolute indication for overnight admission in patients considered clinically appropriate for discharge.
Small
Andrew
A
Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.
Klinke
Peter
P
Della Siega
Anthony
A
Fretz
Eric
E
Kinloch
David
D
Mildenberger
Richard
R
Williams
Malcolm
M
Hilton
David
D
D000368:Aged; D000553:Ambulatory Care; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D002318:Cardiovascular Diseases / Q000209:etiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009551:Night Care; D010343:Patient Admission; D010351:Patient Discharge; D018579:Patient Selection; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome