Objectives: Our goal was to compare recently published Consensus Statement from the SCAI/ACC on appropriateness for same-day PCI with patient characteristics from a real-world same-day PCI experience in the United States.
Background: Recent practice statement published by the SCAI / ACC in 2009 describes patients suitable for outpatient PCI procedures. Whether this practice statement reflects actual real-world practice in the setting of advances in transradial catheterization needs further exploration.
Transradial heart cath recovery lounge
at St. Joseph’s of Atlanta
Methods: Pre-existing, de-identified, quality assurance data from 100 sequential patients undergoing transradial PCI, and same-day discharge were compared with criteria in SCAI/ACC statement on outpatient PCI. Each had been identified post-PCI as uncomplicated and therefore eligible for same day discharged. Specific attention was placed on whether the patients carried any exclusion to same-day discharge.
Results: One hundred six procedures were recorded in 100 patients including 11 women and 89 men, median age 62 (55,71) years all with stable ischemia. Early follow up was done for medication compliance. None were readmitted nor had post-PCI complications. Only 15% met appropriateness criteria for same-day discharge. Older age, distance from the hospital, greater than simple PCI, and the need for specific antiplatelet therapy represented the dominant contraindications to discharge.
Conclusions: Using transradial approaches and structured early follow up by advance practice nurses, same-day discharge can be accomplished successfully in a broad range of patients outside of those suggested by the SCAI/ACC 2009 Consensus Document. Confirmation of these results could result in shorter hospitalizations for US patients and align advances in catheterization technology to optimize heath care delivery.
The article, “A single center experience with same-day transradial-PCI patients: A contrast with published guidelines” may be accessed at http://onlinelibrary.wiley.com/doi/10.1002/ccd.23159/pdf
As interventional cardiologists increasingly perform angiography or angioplasty and stent procedures via radial (wrist) access versus femoral (groin or upper leg) access, it will be imperative to develop training and competency guidelines, according to the first report from the Society for Cardiovascular Angiography and Intervention’s (SCAI) Transradial Working Group released today at the SCAI 2011 Scientific Sessions and published in Catheterization and Cardiovascular Interventions. The report reviews issues such as patient selection and preparation, artery access, catheter and therapy selection, primary PCI, potential complications and training for intervention cardiologists performing procedures via radial access.
Radial access is quite common around the world, though it still remains relatively unused in the United States. Recent research, including the RIVAL Trial presented at the 2011 American College of Cardiology (ACC) 60th Annual Scientific Sessions, has shown radial access is a safe and effective technique, can increase survival for heart attack patients, and is often preferred by patients over femoral access. However, published guidelines for the procedure and training are not yet available.
“Data increasingly show that the radial technique, which many patients find more comfortable, is also safe and effective,” said Ronald P. Caputo, M.D., FSCAI, the report’s lead author and Director of Cardiac Services, St. Joseph’s Hospital in Syracuse, NY. “As this technique is used more frequently in the United States, we want to ensure it is used safely and appropriately.”
The report recommends training focused on three levels of competency based on the individual interventional cardiologist’s level of experience with simple and complex cases, including patients with challenging anatomy. The authors emphasize that interventional cardiology trainees should develop equal competency in both femoral and radial approaches, and guidelines should be developed to address best practices for safe use of the radial technique.
“To ensure patients receive the best possible care, we recommend developing training programs that provide interventional cardiologists with opportunities to learn and test their skills in the radial technique,” said Jennifer A. Tremmel, M.D., M.S., FSCAI, report co-author and Director of the Transradial Program at Stanford University Medical Center in Stanford, CA.
As of 2009, only 4.5 percent of coronary procedures in the United States are performed transradially. The technique is more common in Europe and Asia/Australia, where 30 and 40 percent of procedures are performed via radial access, respectively.
SCAI’s Transradial Working Group has developed a series of regional educational programs for interventional cardiologists to be trained in the use of radial access. The demand for these programs has been high, and SCAI plans to offer at least four programs nationwide in 2011.
The complete report, “Transradial arterial access for coronary and peripheral procedures,” may be accessed at
The Society for Cardiovascular Angiography and Intervention (SCAI).
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