Ziakas A A, Klinke B P, Mildenberger C R, Fretz D E, Williams E M B, Kinloch F R D, Hilton j G J D
Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Am Heart J. 2003 Oct;146(4):699-704. doi: 10.1016/S0002-8703(03)00258-8.
The safety and feasibility of same-day discharge percutaneous coronary intervention (PCI) is still controversial.
Patients (n = 943) had same-day discharge radial PCI between April 1998 and March 2001 in our hospital. Patients were contacted and asked whether they had entry site complications or a repeat angiogram and/or PCI within 24 hours and 1 month after the procedure.
At the time the study was conducted, 811 patients responded, 38 patients had died, and 94 were alive but refused to participate or it was impossible to contact them; 27 patients (2.8%) visited their doctor and/or the hospital within 24 hours after discharge because of entry site complications, and 38 patients (4.0%) visited within 1 month. However, none of the patients had major access site complications or needed to be admitted to the hospital. Within 24 hours from discharge 17 patients (2%) reported chest pain, and only 1 (0.1%) required a repeat angiogram, which did not show target vessel occlusion. During the first month, 94 patients (11.5%) reported chest pain, 11 (1.3%) underwent a repeat angiogram, out of which 4 had subacute vessel closure; 2 of the 132 patients that we could not contact had subacute stent thrombosis within 1 month and died.
None of the patients having same-day discharge radial PCI had major access site complications. Six patients (0.6%) had subacute vessel closure, but none had this during the first 24 hours after discharge. Same-day discharge radial PCI in certain low-risk patients is a safe and feasible strategy.
当日出院的经皮冠状动脉介入治疗(PCI)的安全性和可行性仍存在争议。
1998年4月至2001年3月期间,我院943例患者接受了当日出院的桡动脉PCI治疗。对患者进行随访,询问他们在术后24小时和1个月内是否有穿刺部位并发症或是否进行了重复血管造影和/或PCI。
在进行这项研究时,811例患者做出了回应,38例患者死亡,94例患者存活但拒绝参与或无法联系到他们;27例患者(2.8%)在出院后24小时内因穿刺部位并发症就诊和/或住院,38例患者(4.0%)在1个月内就诊。然而,没有患者发生严重的穿刺部位并发症或需要住院治疗。出院后24小时内,17例患者(2%)报告胸痛,只有1例(0.1%)需要进行重复血管造影,造影结果未显示靶血管闭塞。在第一个月内,94例患者(11.5%)报告胸痛,11例(1.3%)接受了重复血管造影,其中4例发生亚急性血管闭塞;在我们无法联系到的132例患者中,有2例在1个月内发生亚急性支架血栓形成并死亡。
接受当日出院桡动脉PCI治疗的患者均未发生严重的穿刺部位并发症。6例患者(0.6%)发生亚急性血管闭塞,但出院后24小时内均未发生。对于某些低风险患者,当日出院的桡动脉PCI是一种安全可行的策略。