Complex coronary angioplasty: Is the same-day discharge a safe alternative?

Abstract

If the same-day discharge after simple coronary angioplasty (PTCA) is a safe procedure, we don’t know if such an alternative could be attempt in patients (pts) with complex PTCA. To evaluate safety of same-day discharge after coronary angioplaty of complex lesions. Over a 11 months period, all pts referred to our center for a staged PTCA or coronary angiogram and ad-hoc angioplasty of complex coronary artery lesions were prospectively included. Exclusion criteria were pts with acute coronary syndromes, or complicated PTCA. 131 pts (among 328 ambulatory pts with PTCA, 40%), were included, (median age 70, IQR 61-76), (107 men, 81%) (84 pts with ad-hoc PTCA, 64.1%). Median home location to the hospital was 30 kms, (IQR1-3: 10-59) with a median delay of 30 mns, (IQR1-3: 15-50). Procedure was performed through a trans-radial approach in 128 pts (97.7%). PTCA was attempted in 1.54 vessels per pt, 1.79 lesions per pt, with 1.7 stent per pt. 19 pts (14.5%) underwent left main PTCA, 18 (13.7%) total coronary occlusion, 19 (14.5%) bifurcation lesions, and 7 (5.3%) saphenous by pass grafts. Rotablator and shockwave techniques were used in 10 pts, (7.6%). Early ambulation was performed at 1 hour, and discharge at a median time of 5 hours. A call phone was systematically done between 24 and 72 hours after discharge: 20 pts did not answer, (15.3%), and there were no major complication in the 111 remaining pts, (no death, infarction, revascularization or stroke). Same-day discharge after PTCA in pts with complex coronary artery lesions appears to be a very safe procedure and alternative strategy.