Chaumeil Arnaud, Beygui Farzin, Collet Jean-Philippe, Payot Laurent, Choussat Rémi, Drobinski Gérard, Le Feuvre Claude, Helft Gérard, Thomas Daniel, Komajda Michel, Montalescot Gilles
Institute of Cardiology, Pitié-Salpêtrière Hospital Group, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Arch Cardiovasc Dis. 2008 Jun;101(6):383-90. doi: 10.1016/j.acvd.2008.06.002. Epub 2008 Aug 15.
To assess the feasibility and safety of coronary angiography combined, where necessary, with ad hoc angioplasty in an outpatient setting; a prospective, single-center study. The first 172 patients (154 men, 59 +/- 11 years) considered at low risk for complications were enrolled for outpatient-coronary angiography with or without angioplasty via a radial approach. The inclusion criteria were clinical, not based on angiography. After angiography/angioplasty, creatinine and troponin were assayed (outside the hospital) within 24h and patients were telephoned and asked about their clinical condition. Angioplasty was performed in 69 (40%) patients and 130 patients (75.6%) were discharged on the same day. In the angioplasty group, a history of coronary dilatation was more common in patients discharged on the same day (p = 0.05), whereas bifurcation lesions were more frequent in subjects who were kept in hospital (p < 0.0001). No serious complications occurred during the study. Of the 42/172 prolonged hospitalizations, eight were due to minor procedural complications, five due to failure of the radial route and three for indications for bypass surgery; the others were kept in for reasons unrelated to a complication (e.g., the examination was performed late in the day, a particularly complex procedure, etc.). Four (3%) of the 24-hour telephone calls led to a visit, but not hospital admission. Overall, performing angiography and "ad hoc" angioplasty in the course of a single outpatient visit makes it possible to foreshorten the hospital stay and increase patient throughput with a given hospital capacity and, this, without increasing clinical risk. Exactly how these patients are selected remains to be defined and may certainly be improved compared to this initial experiment. An outpatient-coronary angiography and ad hoc angioplasty strategy is a viable option with a low risk for patients selected on the basis of simple clinical criteria. It combines the advantages of increased convenience for the patient and lower costs.
评估在门诊环境中必要时联合冠状动脉造影和临时血管成形术的可行性和安全性；一项前瞻性单中心研究。首批172例被认为并发症风险较低的患者（154例男性，年龄59±11岁）入选接受经桡动脉途径的门诊冠状动脉造影，可选择是否进行血管成形术。纳入标准基于临床情况，而非血管造影结果。血管造影/血管成形术后，在24小时内（院外）检测肌酐和肌钙蛋白，并给患者打电话询问其临床状况。69例（40%）患者接受了血管成形术，130例患者（75.6%）于同日出院。在血管成形术组中，同日出院的患者冠状动脉扩张病史更为常见（p = 0.05），而住院患者分叉病变更为频繁（p < 0.0001）。研究期间未发生严重并发症。在172例延长住院时间的患者中，42例中有8例是由于轻微手术并发症，5例是由于桡动脉途径失败，3例是由于旁路手术指征；其他患者住院是由于与并发症无关（如检查在当天晚些时候进行、手术特别复杂等）。24小时电话随访中有4例（3%）导致患者就诊，但未住院。总体而言，在单次门诊就诊过程中进行血管造影和“临时”血管成形术可以缩短住院时间，并在给定的医院容量下提高患者周转率，而且不会增加临床风险。与最初的这项实验相比，究竟如何选择这些患者仍有待确定，当然可能会有所改进。基于简单临床标准选择的患者，门诊冠状动脉造影和临时血管成形术策略是一种可行的选择，风险较低。它兼具增加患者便利性和降低成本的优点。
