Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA.
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):6-13. doi: 10.1002/ccd.24537. Epub 2012 Sep 20.
To assess clinical outcomes of same-day discharge (SDD) patients after elective percutaneous coronary intervention (PCI).
An overnight stay after PCI has been the standard approach in the majority of institutions. Data supporting SDD while maintaining patient safety, based on contemporary United States practice, have not been well established.
Using institutional pre-, peri-, and post-procedural guidelines, short-term clinical outcomes of 200 consecutive patients discharged on the same day after elective PCI were prospectively studied. Major adverse cardiac events (MACE), access site and vascular complications, readmissions, and emergency room (ER) visits were assessed within 24 hrs and at 7-day post-SDD. MACE included cerebral vascular accidents, death, myocardial infarction, target vessel revascularization, pulmonary embolism, and emergent coronary artery bypass grafting.
The mean age of the population was 63.2 years; 75% were males. Of 200 patients, 75.5% were accessed femorally and 24.5% had radial access. Intra-procedural anticoagulation included bivalirudin alone (47%), bivalirudin with glycoprotein (GP) IIb/IIIa inhibitors (3.5%), heparin alone (37%), and heparin with GP IIb/IIIa inhibitors (12.5%). No major bleeding or MACE was reported within 24 hrs or at 7 days. Within 7 days, 8 (4%) patients experienced minor bleeding, 4 (2%) were readmitted, and 3 (1.5%) had ER visits only. Pseudoaneurysm occurred in 1 (0.5%) patient.
Our institution-specific guidelines identify low-risk PCI patients who can be safely considered candidates for SDD with virtually no short-term adverse consequences.
评估择期经皮冠状动脉介入治疗（PCI）后当日出院（SDD）患者的临床结局。
在大多数机构中，PCI 后过夜住院是标准方法。基于美国当代实践，尚未充分确立支持 SDD 同时保障患者安全的数据。
使用机构术前、术中和术后指南，前瞻性研究了 200 例连续接受择期 PCI 并在当日出院的患者的短期临床结局。主要不良心脏事件（MACE）、入路和血管并发症、再入院和急诊室（ER）就诊在 24 小时内和 SDD 后 7 天进行评估。MACE 包括脑血管意外、死亡、心肌梗死、靶血管血运重建、肺栓塞和紧急冠状动脉旁路移植术。
人群的平均年龄为 63.2 岁；75%为男性。200 例患者中，75.5%经股动脉入路，24.5%经桡动脉入路。术中抗凝包括单独使用比伐卢定（47%）、比伐卢定联合糖蛋白（GP）IIb/IIIa 抑制剂（3.5%）、单独使用肝素（37%）和肝素联合 GP IIb/IIIa 抑制剂（12.5%）。24 小时内或 7 天内无重大出血或 MACE 发生。7 天内，8 例（4%）患者发生轻微出血，4 例（2%）患者再入院，3 例（1.5%）仅到 ER 就诊。1 例（0.5%）患者发生假性动脉瘤。
我们机构特有的指南确定了可以安全考虑作为 SDD 候选者的低危 PCI 患者，几乎没有短期不良后果。
