Document Detail


Early and late outcomes in patients excluded from same-day home discharge after transradial stenting and maximal antiplatelet therapy.
MedLine Citation:
PMID:  18942124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To develop a safe practice of same-day discharge after percutaneous coronary intervention (PCI), it is important to identify early the patients who need to remain hospitalized and potentially require more careful follow-up. In the EASY trial, a large number of patients with acute coronary syndromes were enrolled prior to PCI to be randomized between same-day discharge or overnight hospitalization. Based on a few angiographic criteria, suboptimal results, or clinical complications, some patients were excluded from randomization after PCI. OBJECTIVES: We report the early and late outcomes of those patients, and evaluate the use of simple criteria precluding same-day discharge. RESULTS: The rate of major adverse cardiac events including death, myocardial infarction, and target vessel revascularization in patients excluded from randomization (n = 343) was significantly higher at 30 days (10.2% vs. 1.6%), 6 months (17.5% vs. 5.6%), and 12 months (24.5% vs. 9%) compared with randomized patients (n = 1,005; P < 0.0001). At 12 months, only transient vessel closure (HR 1.78, 95% CI 1.10-2.65, P = 0.023) and a residual dissection >or= grade B post-PCI (HR 1.53, 95% CI 1.11-2.05, P = 0.011) were independent predictive factors of adverse outcomes. CONCLUSION: Criteria associated with angiographic suboptimal results or clinical complications are useful to identify patients ineligible for same-day discharge after PCI, regardless of the clinical presentation. Patients excluded from same-day discharge after PCI for safety concerns have worse early and late outcomes. Transient vessel closure and persisting moderate dissection after PCI remain independent predictors of late adverse outcomes after PCI with maximal antiplatelet therapy.
Authors:
Olivier F Bertrand; Josep Rodés-Cabau; Eric Larose; Guy Proulx; Onil Gleeton; Can Manh Nguyen; Isabelle Nault; Louis Roy; Paul Poirier; Olivier Costerousse; Robert De Larochellière
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  72     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-01-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  619-25     Citation Subset:  IM    
Copyright Information:
(c) 2008 Wiley-Liss, Inc.
Affiliation:
Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, Canada. olivier.bertrand@crhl.ulaval.ca
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / mortality,  radiography,  therapy*
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects,  instrumentation,  mortality
Cardiovascular Diseases / etiology,  mortality,  prevention & control*
Coronary Angiography
Female
Humans
Length of Stay*
Male
Middle Aged
Night Care
Patient Discharge*
Patient Selection
Platelet Aggregation Inhibitors / therapeutic use*
Radial Artery
Risk Assessment
Stents*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2008 Nov 1;72(5):626-8   [PMID:  18949777 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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