When interventional cardiologists use the radial artery in the wrist to thread slender catheters into the heart for angioplasty and stenting, many patients can safely go home the same day-even some with chronic medical conditions and complex blockages-according to a study presented today at the Society for Cardiovascular Angiography and Interventions (SCAI) 33rd Annual Scientific Sessions.
The study showed that a low rate of complications enables a much wider range of patients than might be expected to go home within hours of undergoing percutaneous coronary intervention (PCI) initiated through a needle puncture in the radial artery in the wrist, rather than the femoral artery in the groin, as is traditional in the United States.
"The transradial techniques that have been introduced over the last decade have changed the PCI procedure dramatically," said Ian Gilchrist, MD, FSCAI, a professor of medicine at Penn State College of Medicine in Hershey, Pa. "This study challenges conventional thinking that PCI patients must stay overnight."
Traditional PCI through the femoral artery is complicated by serious bleeding in about 6 percent of patients. To avoid this complication, patients must lie flat for several hours after the procedure, while pressure is applied to the puncture site or a closure device plugs the wound. For many patients, especially those with back or hip problems, enforced bed rest is painful and inconvenient. In addition, most patients stay overnight in the hospital as a safety precaution.
By comparison, the bleeding risk with radial PCI is minimal, and because of the location and small size of the puncture wound, patients can safely sit up in a chair while they recover from the procedure, walk around, eat and drink, and use the restroom. Radial PCI, though gaining the interest of U.S. cardiologists, is performed in only a tiny fraction of cases in this country, however.
For the study, Dr. Gilchrist and his colleagues set out to document the types of patients who safely underwent radial PCI and were discharged home the same day from a medical center with a decade's experience in the procedure. Researchers analyzed data from 100 patients who had a total of 106 uncomplicated PCI procedures using radial techniques, focusing on clinical and procedural characteristics that traditionally would have excluded patients from having an outpatient procedure.
The average age of patients was 62, although 26 were older than 70 years. Five patients had insulin-dependent diabetes; one had reduced kidney function; eight had chronic breathing problems requiring medication; four had allergies to the contrast dye used to visualize the arteries during the procedure; four had plaque build-up in more than one artery in the heart; and six had either plaque build-up in the arteries of the legs, congestive heart failure, or a prior heart transplant. Sixty-two patients lived more than 20 miles from the hospital (average, 54 miles). In addition, 23 patients underwent complex PCI, including procedures in multiple arteries, in arteries supplying blood to a large portion of the heart, or in clogged vessels previously implanted during bypass graft surgery.
Altogether, only 15 percent of patients fit traditional criteria for same-day discharge after PCI. However, no patients were readmitted to the hospital or experienced any complications after PCI.
"A broad range of patients who have transradial PCI can be discharged the same day if they have had an uneventful procedure without complications," Dr. Gilchrist said. "Decisions about same-day discharge should be based on procedural outcome, rather than pre-procedural characteristics."
Dr. Gilchrist reports no conflicts of interest related to this study.
The study "Real World, Same-Day Transradial-PCI Patients In The US: Do the Guidelines Fit Practice?" will be presented at a poster session on Wednesday, May 5, 12:30 p.m. to 5:00 p.m.