Ambulatory discharge after transradial coronary intervention: Preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study).
BACKGROUND
Although the safety and cost-effectiveness of same-day discharge after uncomplicated transradial percutaneous coronary intervention (TR-PCI) is well established in Europe and Asia, such data are not available for US patients.


METHODS
All patients who underwent TR-PCI at our high-volume US medical center between 2004 and 2007 were included in this study. The primary end point was in-hospital adverse clinical outcomes between 6 and 24 hours postprocedure.


RESULTS
A total of 450 patients were included in this study (aged 59 +/- 11 years). Of these, 13% were female, 27% were diabetic, 6% had peripheral vascular disease, and 5% had chronic kidney disease. Procedural indications included stable angina (49%), unstable angina (31%), non-ST elevation myocardial infarction (NSTEMI) (17%), and ST elevation myocardial infarction (STEMI) (3%). All patients received an intra-arterial cocktail of heparin, verapamil, and nitroglycerin, and 13% of patients received glycoprotein IIb/IIIa inhibitors. Seven percent of patients had 3-vessel disease, 3% had bypass grafts stenoses, and 20% had class B(2)/C lesions. Procedural success rate was 96%. A total of 24 (5.3%) postprocedural complications were observed; however, none occurred between hours 6 to 24, the time differential between same-day and next-day discharge. Thirteen patients (2.9%) experienced significant complications within the first 6 hours (MI, urgent repeat revascularization, and ventricular tachycardia). Eleven (2.4%) spontaneously resolved minor access complications developed. There were 12 same-day discharges according to the operators' discretion; none required readmission.


CONCLUSIONS
Although a low incidence of complications did occur, none would have been impacted by same-day discharge. Those observed before 6 hours would have prevented early discharge, and those occurring after 24 hours would have been unaffected by routine next-day discharge. This observational study demonstrated the safety and feasibility for a prospective evaluation of ambulatory TR-PCI in an American practice setting.
Jabara
Refat
R
Saint Joseph's Cardiovascular Research Institute, Saint Joseph's Hospital of Atlanta, Atlanta, GA 30342, USA. rjabara@sjha.org
Gadesam
Radhika
R
Pendyala
Lakshmana
L
Chronos
Nicolas
N
Crisco
Larry V
LV
King
Spencer B
SB
Chen
Jack P
JP
D000046:Academic Medical Centers; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000787:Angina Pectoris / Q000191:economics / Q000628:therapy*; D000789:Angina, Unstable / Q000191:economics / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000379:methods; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D017534:Radial Artery