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Early and late outcomes in patients excluded from same‐day home discharge after transradial stenting and maximal antiplatelet therapy
Author(s) -
Bertrand Olivier F.,
RodésCabau Josep,
Larose Éric,
Proulx Guy,
Gleeton Onil,
Nguyen Can Manh,
Nault Isabelle,
Roy Louis,
Poirier Paul,
Costerousse Olivier,
De Larochellière Robert
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21662
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , randomization , myocardial infarction , revascularization , randomized controlled trial , cardiology , adverse effect , single center , clinical endpoint , surgery
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 ≥ 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. © 2008 Wiley‐Liss, Inc.