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| FEASIBILITY
AND SAFETY OF OUTPATIENT PERCUTANEOUS CORONARY ARTERY INTERVENTION
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M. Brzezinski, A. Basti, P-C. Fournet, J. Noble, P. Schopfer,
L. Finci and P. Urban. |
| Hopital
de la Tour, Geneve, Switzerland |
Elective
percutaneous coronary interventions (PCI) are currently associated
with success rates >95% and no longer require complex post-intervention
monitoring and management. We evaluated the feasibility and safety
of outpatient PCI in patients scheduled to remain in our hospital
for less than 24 hours. 209 consecutive outpatients underwent
PCI between January 1998 and December 2000. in 89% of cases this
was done during the same session as diagnostic coronarography
("ad hoc" PCI). the patients (age 64 +/- 20, 23% female) were
investigated because of stable angina (68%), unstable 13,4%),
silent ischeamia (12%), or post MI (6,6%). 104 patients (50%)
had single, 105 (50%) multiple vessel disease and 22 (11%) had
prior CABG. The procedure, through a femoral 6F sheath, was successful
in 205 patients (98,1%), with 4 failures (1,9%), related to chronic
total occlusion. 173 patients (83%) underwent single vessel and
36 (17%) multivessel PCI. 37 (18%) had PTCA only, 115 (55%) had
one stent and 57 (27%) had ³ 2 stents implanted. After PCI, all
patients were monitored 2 to 6 hours in the ICU before returning
to the outpatient ward. During the hospital period, there were
no deaths or need for emergent CABG. 1 patient (0,5%) suffered
from a Q wave and 3 (1,4%) a non-Q wave myocardial infarction.
3 of these 4 patients (1,4%) remained in hospital for more than
24 hours. One patient (0,5%) was successfully treated as an outpatient
for an access site pseudo-aneurysm. 100 of the first 103 patients
could be contacted for a routine 30 days follow up. There was
no death, further myocardial infarction, need for CABG or hospital
readmission. Ambulatory PCI appears feasible and safe, only rarely
requires conversion to full hospitalisation and should prove to
be a cost-effective approach for myocardial revascularisation.
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