Inserm, Centre d'Investigation Clinique 006, U955 équipe 3, Créteil, France.
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):15-23. doi: 10.1002/ccd.24545. Epub 2012 Nov 14.
The aim of this prospective, multicenter study was to assess the safety, feasibility, acceptance, and cost of ambulatory transradial percutaneous coronary intervention (PCI) under the conditions of everyday practice.
Major advances in PCI techniques have considerably reduced the incidence of post-procedure complications. However, overnight admission still constitutes the standard of care in most interventional cardiology centers.
Eligibility for ambulatory management was assessed in 370 patients with stable angina referred to three high-volume angioplasty centers. On the basis of pre-specified clinical and PCI-linked criteria, 220 patients were selected for ambulatory PCI.
The study population included a substantial proportion of patients with complex procedures: 115 (52.3%) patients with multivessel coronary artery disease, 50 (22.7%) patients with multilesion procedures, and 60 (21.5%) bifurcation lesions. After 4-6 hr observation period, 213 of the 220 patients (96.8%) were cleared for discharge. The remaining seven (3.2%) patients were kept overnight for unstable angina (n = 1), atypical chest discomfort (n = 2), puncture site hematoma (n = 1), or non-cardiovascular reasons (n = 3). Within 24 hr after discharge, no patients experienced readmission, stent occlusion, recurrent ischemia, or local complications. Furthermore, 99% of patients were satisfied with ambulatory management and 85% reported no anxiety. The average non-procedural cost was lower for ambulatory PCI than conventional PCI (1,230 ± 98 Euros vs. 2,304 ± 1814 Euros, P < 10(-6)).
Ambulatory PCI in patients with stable coronary artery disease is safe, effective, and well accepted by the patients. It may both significantly reduce costs and optimize hospital resource utilization.
本前瞻性、多中心研究旨在评估在日常实践条件下经桡动脉入路行门诊经皮冠状动脉介入治疗（PCI）的安全性、可行性、可接受性和成本效益。
PCI 技术的重大进步已显著降低了术后并发症的发生率。然而，在大多数介入心脏病学中心，过夜住院仍然是标准的治疗方法。
在 370 例稳定型心绞痛患者中评估了门诊管理的条件，这些患者被转诊至 3 个大容量的血管成形术中心。根据预先设定的临床和 PCI 相关标准，220 例患者被选择进行门诊 PCI。
研究人群包括相当一部分复杂病例：115 例（52.3%）患者患有多支血管冠状动脉疾病，50 例（22.7%）患者接受了多部位病变治疗，60 例（21.5%）患者存在分叉病变。在 4-6 小时的观察期后，220 例患者中的 213 例（96.8%）获准出院。其余 7 例（3.2%）患者因不稳定型心绞痛（n=1）、非典型胸痛（n=2）、穿刺部位血肿（n=1）或非心血管原因（n=3）而被留院过夜。在出院后 24 小时内，无患者再入院、支架闭塞、再次缺血或局部并发症。此外，99%的患者对门诊管理感到满意，85%的患者表示没有焦虑。与传统 PCI 相比，门诊 PCI 的非手术费用较低（1230±98 欧元 vs. 2304±1814 欧元，P<10(-6)）。
在稳定型冠状动脉疾病患者中进行门诊 PCI 是安全、有效且患者易于接受的。它既能显著降低成本，又能优化医院资源利用。
