Koutouzis Michael, Liontou Catherine, Xenogiannis Iosif, Tajti Peter, Tsiafoutis Ioannis, Lazaris Efstathios, Oikonomidis Nikolaos, Kontopodis Eleftherios, Rangan Bavana, Brilakis Emmanouil
Red Cross General Hospital, Athens, Greece.
Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):1232-1239. doi: 10.1002/ccd.29320. Epub 2020 Oct 13.
To assess the feasibility and safety of same day discharge (SDD) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
CTO PCI has been associated with higher complication rates and procedural and hospitalization costs. Shortening post-PCI hospitalization length not only increases the patients' comfort but at the same time it consists an important part of cost reduction policies.
We retrospectively compared the 30-day outcomes of patients who underwent CTO PCI at the Red Cross Hospital, Greece between January 2016 and June 2019 and underwent SDD versus non-SDD. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction, urgent repeat target vessel revascularization, tamponade, and stroke.
A total of 173 patients (mean age 63.7 ± 8.9 years) were included, of whom 51 (30%) underwent SDD. SDD patients were less likely to have diabetes mellitus (51 vs. 31%, p = .015), arterial hypertension (89 vs. 67%, p < .001), and acute coronary syndrome presentation (39.7 vs. 21.6%, p = .022), compared with non-SDD patients. Forearm access was used in all SDD patients and in 83% of the non-SDD patients. The 30-day incidence of MACE was 0% in the SDD group and 1.6% in the non-SDD group. Multivariable analysis showed that diabetes mellitus and longer procedural time were associated with lower probability of SDD (OR: 0.34, 95% CI: 0.15, 0.73 and OR: 0.29, 95% CI: 0.12, 0.71, respectively).
SDD appears to be feasible and safe in selected patients undergoing an uncomplicated CTO PCI through forearm approach.
评估慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）后当日出院（SDD）的可行性和安全性。
CTO PCI与更高的并发症发生率以及手术和住院费用相关。缩短PCI后的住院时间不仅能提高患者的舒适度，同时也是降低成本政策的重要组成部分。
我们回顾性比较了2016年1月至2019年6月在希腊红十字医院接受CTO PCI且进行了SDD与未进行SDD的患者的30天结局。主要不良心血管事件（MACE）定义为死亡、心肌梗死、紧急再次靶血管血运重建、心包填塞和中风的综合。
共纳入173例患者（平均年龄63.7±8.9岁），其中51例（30%）进行了SDD。与未进行SDD的患者相比，进行SDD的患者患糖尿病（51%对31%，p = 0.015）、动脉高血压（89%对67%，p < 0.001）和急性冠状动脉综合征表现（39.7%对21.6%，p = 0.022）的可能性较小。所有进行SDD的患者和83%未进行SDD的患者采用了前臂入路。SDD组30天MACE发生率为0%，未进行SDD组为1.6%。多变量分析显示，糖尿病和手术时间较长与SDD可能性较低相关（OR分别为：0.34，95%CI：0.15，0.73和OR：0.29，95%CI：0.12，0.71）。
对于通过前臂入路进行无并发症CTO PCI的特定患者，SDD似乎是可行且安全的。
