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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Same-day discharge PCI: An exploratory analysis on the limiting steps of a paradigm shift
Session:
Posters 4 - Écran 8 - Cardiologia de Intervenção
Speaker:
Afonso Félix Oliveira
Congress:
CPC 2019
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Posters
FP Number:
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Authors:
Afonso Félix De Oliveira; Sérgio Madeira; João Brito; Manuel Almeida; Cláudia Jesus Silva; Luís Raposo ; Pedro de Araújo Gonçalves; Henrique Gabriel; Marisa Trabulo; Jorge Santos Ferreira; Rui Campante Teles; Miguel Mendes
Abstract
<p><strong>Introduction: </strong>The current paradigm for post-PCI care in elective patients is still overnight ward stay. However, same-day discharge PCI (SDD-PCI) has been demonstrated to be feasible and safe with potential gains in patient comfort and resource allocation. Appropriate criteria for SDD-PCI and an economical analysis of this practice in Portugal have not been defined. The aim of this work is to simulate patient selection protocols and generate the discussion on the limiting steps of this paradigm shift.</p> <p><strong>Methods: </strong>We performed cross sectional study of 1002 PCIs performed in outpatients for stable coronary disease between Jan/2015 and Dec/2018. Eligibility for SDD-PCI was determined in the case of an outpatient, with successful and uncomplicated procedure, using radial artery access. Two possible protocols with the following exclusion criteria were then applied: 1. Primary - more than one vessel treated, bifurcation lesion PCI, left main PCI or graft-PCI ; 2. Secondary - General criteria plus age < 80 yo, LVEF < 30%, GFRe < 30mL/min and blood pressure > 180/100 during procedure.</p> <p><strong>Results: </strong>From the initial group of 1002 PCIs for stable coronary artery disease in outpatients, 750 (74,8%) were eligible for SSD-PCI according to pre-specified criteria. Patients were excluded due to non-radial access in 247 cases (24,7%) and due to procedural complications in 9 cases (0.8%). If the Primary protocol was applied, 533 out of 750 (71%) would be included in the SDD-PCI protocol. The main reasons for exclusion were: more than one vessel treated - 150 (20%) ; bifurcation lesion - 78 (10,4%) ; Left main PCI - 23 (9,2) and Graft-PCI 13 (1,7%). If the secondary protocol was applied, 436 out of 533 (82%) would be included in a SSD-PCI program. The reasons for exclusion were age > 80 (58 ; 11%), reduced LVEF (11 ; 2%), impaired renal function (10 ; 2%) and severe hypertension (30 ; 7%). The application of the primary protocol would lead to 133 patients/year eligible for SDD-PCI, while the secondary protocol would lead to 109 patients/year. </p> <p><strong>Conclusions: </strong>The future of elective PCI will likely evolve towards systematic use of SDD-PCI. Our work analyzed the impact of two SDD-PCI protocols on patient selection and illustrated the need for further refinement of SDD-PCI strategies and cost-effectiveness analysis.</p>
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