title: Transradial percutaneous coronary intervention without on-site cardiac surgery for stable coronary disease and myocardial infarction: preliminary report and initial experience in 174 patients.
abstract: BACKGROUND
  On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease.
  
  
  OBJECTIVE
  To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country.
  
  
  METHODS
  Of the 174 patients who underwent PCI for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches.
  
  
  RESULTS
  The study group comprised 131 patients with stable coronary disease and 43 with acute MI. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 +/- 2 hours). In the acute MI group, the length of stay was 6.6 +/- 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention).
  
  
  CONCLUSIONS
  The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost-effective than the femoral approach.
authors.affiliation: Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA. orlando.escarcega@tuhs.temple.edu
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escárcega
authors.forename: Juan C
authors.initials: JC
authors.lastname: Pérez-Alva
authors.forename: Mario
authors.initials: M
authors.lastname: Jiménez-Hernández
authors.forename: Claudia
authors.initials: C
authors.lastname: Mendoza-Pinto
authors.forename: Ruben S
authors.initials: RS
authors.lastname: Pérez
authors.forename: Renán S
authors.initials: RS
authors.lastname: Porras
authors.forename: Mario
authors.initials: M
authors.lastname: García-Carrasco
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000379:methods*; D006328:Cardiac Catheterization / Q000191:economics / Q000379:methods*; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003906:Developing Countries; D005240:Feasibility Studies; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017534:Radial Artery; D016896:Treatment Outcome