Outpatient percutaneous coronary intervention: Ready for prime time?
| Autor: | Jacques R. Rouleau, Josep Rodés-Cabau, Can Manh Nguyen, Louis Roy, Jean-Roch Boudreault, Eric Larose, Olivier F. Bertrand, Onil Gleeton, Robert De Larochellière, Bernard Noël, Gérald Barbeau, Jean-Pierre Déry, Guy Proulx |
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| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Time Factors Abciximab medicine.medical_treatment Myocardial Infarction Psychological intervention Coronary Artery Disease Coronary artery disease Immunoglobulin Fab Fragments Ambulatory care Acute care Ambulatory Care medicine Humans Angioplasty Balloon Coronary Intensive care medicine The Quebec Heart Institute business.industry Coronary Stenosis Quebec Antibodies Monoclonal Percutaneous coronary intervention Stent medicine.disease Patient Discharge Conventional PCI Platelet aggregation inhibitor Stents Medical emergency Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors |
| Zdroj: | Canadian Journal of Cardiology. 23:58B-66B |
| ISSN: | 0828-282X |
| Popis: | Outpatient practice after percutaneous coronary intervention (PCI) is gaining momentum due to constantly optimizing results. Furthermore, the availability of limited beds to handle the large volume of coronary interventions also promotes outpatient practice. The present report relates the current experience with same-day discharge and defines persisting challenges in promoting accelerated in-hospital turnover. Since the mid-1990s, there have been several reports on same-day discharge following uncomplicated procedures. Overall, the success of outpatient PCI practice is based on a few technological and pharmacological advances. First, the systematic use of stents and potent antiplatelet agents have revolutionized the acute success rates of PCI by virtually eliminating the risks of acute vessel closure within the first 24 h following a successful procedure. Second, the miniaturization of catheter sizes has also simplified access site management, accelerated ambulation time and limited the risks of puncture site bleeding. In this regard, the transradial approach initially described in Canada and later popularized in Europe has transformed the acute care of patients after PCI. Today, however, the practice of transradial PCI still varies largely from country to country. From the literature review, it appears that after a short period of observation (4 h to 6 h), the majority of eligible patients who have undergone uncomplicated coronary stenting can be discharged on the same day. Whereas implementation of same-day discharge to referring centres is simple, home discharge requires the development of structured outpatient programs with dedicated resources to assist the patient and family with short-term logistics, to provide reassurance, to serve as a ‘safety net’ and, lastly, to promote medication compliance and cardiovascular risk factor management. Further studies are required to better define the cost-minimization effects of outpatient PCI practice, as well as patient perception of fast-track PCI. It is proposed that outpatient PCI will likely continue to expand over the next decade. |
| Databáze: | OpenAIRE |
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