B. Herman

Safety of same day discharge following percutaneous coronary intervention

BACKGROUND There is a body of literature reporting the safety of discharging patients the same day as percutaneous coronary revascularisation. Nevertheless, overnight stay continues to be the general standard of care. METHODS Over a single calendar year, 130 patients having elective, percutaneous coronary revascularisation were discharged home the day of the procedure with the majority of procedures using radial access. Patients were observed post procedure for six hours and if no problems occurred, discharge was undertaken. The purpose of the study was to assess complications in the 24 hours following discharge. RESULTS Within the following 24 hours post discharge, there were no complications reported including bleeding, recurrent ischaemia, or hospitalisation. CONCLUSION Same day discharge following elective percutaneous revascularisation appears both efficacious and safe with a low risk of post discharge complications.

Safety and Efficacy of Offsite Percutaneous Coronary Interventions in 1,348 Consecutive Patients in Rural Tasmania

Despite controversy, a growing body of data exists suggesting that percutaneous coronary intervention (PCI) with no surgical onsite availability is safe and efficacious. Over a period of 3 years all patients requiring PCI had their intervention performed at the Launceston General Hospital, a regional hospital serving rural Tasmania, Australia. There were no exclusion criteria uniformly adopted. Primary end points included angiographic success and major procedure-related complications. A total cohort of 1,348 consecutive patients underwent PCI during the calendar years of 2005 through 2007, including patients with ST-elevation myocardial infarction. Angiographic success for all patients was >98%. In-hospital mortality was 0.8% overall. Only 1 patient required urgent transfer to a cardiac surgical center. Bleeding rates requiring transfusion were approximately 1%. Excellent clinical outcomes have been achieved in a relatively remote PCI center in rural, northern Tasmania, where there is no emergency cardiac surgical availability. Angiographic success was high and complication rates were low, consistent with worldwide standards. In conclusion, PCI without onsite surgery appears safe and efficacious when well-trained staffing is available.