SPC365

Ambulatory PCI Analysis - insights from single center experience

Session: Sessão de Posters 29 - Intervenção coronária percutânea
Speaker: António Maria Rocha de Almeida

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Cartazes
FP Number: ---
Authors: António Maria Rocha De Almeida; Miguel Carias de Sousa; Marta Paralta Figueiredo; Rafael Viana; Francisco Claudio; Renato Fernandes; Angela Bento; David Neves; Diogo Bras; Kisa Congo; Manuel Trinca; Lino Patricio

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">Background</span></span></span></strong><br />
<span style="font-size:10.0pt"><span style="color:black"><span style="background-color:white">Percutaneous coronary intervention (PCI) has undergone rapid evolution lately and is currently generalized as a therapeutic option. It was associated with significant rate of complications, yet, with the improvement of new generation drug eluting stents, and introduction of radial access (RA), PCI has become safer, with a minimum number of complications. This allows earlier hospital discharge, helping to ease the pressure on wards management. The evolution of PCI urged the development of outpatient PCI programs</span>. <span style="background-color:white">This study aims to describe our center four-year experience of ambulatory PCI program, in terms of safety and efficacy.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">Methods</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:black">Single center, retrospective, cohort of 749 ambulatory PCI from 2019 till 2022 was <span style="background-color:white">evaluated. We excluded patients with acute coronary syndromes or admitted for other non-PCI related reasons. Outcomes assessed were non-planned hospital admission and early PCI complications.</span> </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">Results</span></span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">From the total of 2142 PCI, 749 (35%) were performed in ambulatory setting. Patients&rsquo; mean age was 67&plusmn;10 years, and 22% (n=165) patients were female. In 24% of the cases, the coronary anatomy was previously known, and 30% had history of myocardial infarction. 65% had a normal left ventricle ejection fraction (LVEF), 6% had a moderate depression of LVEF and 3% had LVEF severe depression. Before PCI median creatinine value was 0,9 (IQ 0,58-1,2). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">RA was possible in 83% cases, and access size was 6Fr in 73%. The RA hemostasis was obtained by external compression device and femoral access (FA) hemostasis was first intended by closing device, but in 17% of the transfemoral PCI access had to be manual compressed, due to device failure or not suitable. PCI was successful in 95% of the cases, with revascularization of the target lesion. 27% were complex PCI. The unsuccessful PCI procedures (5%) were attributed to uncrossable lesions in 4% and no reflow/slow flow after PCI in 1% and &lt;0,1% death (n=1).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">2,4% patients had to be admitted, after planned outpatient PCI, 1,3% to surveillance of access site (100% FA, after closing device and manual compression failure), 0,5% due to PCI complication, with small coronary perforation and 0,6% to hydrate due to risk of contrast induced nephropathy. &nbsp;There was a higher risk of unplanned hospital admission in patients submitted to transfemoral PCI (p&lt;0,05 OR 6,8 [2,5-18,7]), and there was no statistically significant relation between unplanned admission and patient&rsquo;s LVEF (p=0,6), creatinine value (p=0,09) and complex PCI (p=0,1). There were no early episodes of death, MACE, non-planned hospital readmission and stent failure.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Conclusion</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">PCI has become a predictable and reliable technique, capable to treat outpatients. Patients undergoing successful, either complex or not, PCI, without events, can safely be discharged on the same day. Outpatient PCI helps with the functioning of inpatient care, allowing beds to be freed up for other situations.</span></span></span></span></span></p>