Outpatient percutaneous coronary intervention: Ready for prime time?

• Published in: Canadian journal of cardiology 2007-10, Vol.23 (Suppl B), p.58B-66B
• Main Authors: Bertrand, Olivier F., MD PhD, Larose, Eric, DVM MD, De Larochellière, Robert, MD, Proulx, Guy, MD, Nguyen, Can Manh, MD, Déry, Jean-Pierre, MD MSc, Gleeton, Onil, MD, Barbeau, Gérald, MD, Noël, Bernard, MD, Rouleau, Jacques, MD, Boudreault, Jean-Roch, MD, Roy, Louis, MD, Rodés-Cabau, Josep, MD
• Format: Article
• Language: English
• Subjects: Abciximab; Abciximab, Discharge, Percutaneous transluminal coronary angioplasty, Radial, Stent; Ambulatory Care - methods; Ambulatory Care - standards; Angioplasty, Balloon, Coronary; Antibodies, Monoclonal - therapeutic use; Cardiovascular; Coronary Artery Disease - drug therapy; Coronary Artery Disease - therapy; Coronary Stenosis - drug therapy; Coronary Stenosis - therapy; Humans; Immunoglobulin Fab Fragments - therapeutic use; Myocardial Infarction - drug therapy; Myocardial Infarction - therapy; Patient Discharge; Platelet Aggregation Inhibitors - therapeutic use; Quebec; Stents; The Quebec Heart Institute; Time Factors
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/S0828-282X(07)71012-7

Outpatient practice after percutaneous coronary intervention (PCI) is gaining momentum due to constantly optimizing results. Furthermore, the availability of limited beds to handle the large volume of coronary interventions also promotes outpatient practice. The present report relates the current experience with same-day discharge and defines persisting challenges in promoting accelerated in-hospital turnover. Since the mid-1990s, there have been several reports on same-day discharge following uncomplicated procedures. Overall, the success of outpatient PCI practice is based on a few technological and pharmacological advances. First, the systematic use of stents and potent antiplatelet agents have revolutionized the acute success rates of PCI by virtually eliminating the risks of acute vessel closure within the first 24 h following a successful procedure. Second, the miniaturization of catheter sizes has also simplified access site management, accelerated ambulation time and limited the risks of puncture site bleeding. In this regard, the transradial approach initially described in Canada and later popularized in Europe has transformed the acute care of patients after PCI. Today, however, the practice of transradial PCI still varies largely from country to country. From the literature review, it appears that after a short period of observation (4 h to 6 h), the majority of eligible patients who have undergone uncomplicated coronary stenting can be discharged on the same day. Whereas implementation of same-day discharge to referring centres is simple, home discharge requires the development of structured outpatient programs with dedicated resources to assist the patient and family with short-term logistics, to provide reassurance, to serve as a ‘safety net’ and, lastly, to promote medication compliance and cardiovascular risk factor management. Further studies are required to better define the cost-minimization effects of outpatient PCI practice, as well as patient perception of fast-track PCI. It is proposed that outpatient PCI will likely continue to expand over the next decade.