Safe and feasible immediate retransfer of patients to the referring hospital after acute coronary angiography and percutaneous coronary angioplasty for patients with acute coronary syndrome
Restricted accessResearch articleFirst published online September, 2013
Safe and feasible immediate retransfer of patients to the referring hospital after acute coronary angiography and percutaneous coronary angioplasty for patients with acute coronary syndrome
The challenge with fast track (FT) is to avoid compromising medical safety. We aimed to investigate whether patients with acute coronary syndrome could be safely retransferred to the referral hospital on the same day after coronary angiography and/or percutaneous coronary angioplasty (PCI).
Methods and results:
A total of 399 consecutive patients were prospectively randomized: 206 to ordinary care (OC) and 193 to the FT group. Of these, 30% of patients were admitted for unstable angina pectoris and 70% for non-ST-segment elevation myocardial infarction. The FT patients were evaluated for possible same-day return after angiography and/or PCI. Crossover, acute, and 30-day major events were recorded. The radial approach was used in 91 and 87% in the OC and FT group, respectively. Of the FT patients, 95% were returned on the same day and nine crossover patients (4.7%) the next day or later. Major events occurred in nine patients (2.2%); five in the OC and four in the FT group. There were a total of five events within 24 hours. No events were observed during transportation and there were no early retransfers.
Conclusions:
Immediate written reports and good communication with the referring hospital enabled thoroughly selected patients to be safely returned on the same day as angiography and/or PCI.
SzczesnyWDabrawieckiSSzmytkowskiJ. Fast track surgery – pathophysiological foundations and contemporary use [review in Polish, English]. Chirurgia Polska2007; 9: 170–179.
2.
LyonsSM. The medical fast-track. Anaesthesia1994; 49: 841–842.
3.
JollySSYusufSCairnsJ. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet2011; 377: 1409–1420.
4.
PrasadAGershBJBertrandME. Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes: an analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol2009; 54: 477–486.
5.
MehranRRaoSVBhattDL. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation2011; 123: 2736–2747.
6.
VendramettoFOberhollenzerRPitscheiderW. [Percutaneous coronary intervention and immediate re-transfer to the referring hospital for patients with acute coronary syndrome. A single-centre experience]. G Ital Cardiol (Rome)2006; 7: 281–286.
7.
DoDHDaleryKGervaisA. Same-day transfer of patients with unstable angina and non-ST segment elevation myocardial infarction back to their referring hospital after angioplasty. Can J Cardiol2006; 22: 405–409.
8.
OmlandT. Sensitive cardiac troponin assays: sense and sensibility. Eur Heart J2012; 33: 944–946.
9.
SmithSCDoveJTJacobsAK. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines) – executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol2001; 37: 2215–2239.
10.
CaliffRMAbdelmeguidAEKuntzRE. Myonecrosis after revascularization procedures. J Am Coll Cardiol1998; 31: 241–251.
11.
KleinLW. Significance of creatine kinase release after coronary interventions. Catheter Cardiovasc Interv1999; 48: 130–132.
12.
KiniAKiniSMarmurJD. Incidence and mechanism of creatine kinase-MB enzyme elevation after coronary intervention with different devices. Catheter Cardiovasc Interv1999; 48: 123–129.
13.
KingSBYehWHolubkovR. Balloon angioplasty versus new device intervention: clinical outcomes. A comparison of the NHLBI PTCA and NACI registries. J Am Coll Cardiol1998; 31: 558–566.
14.
BertrandMERupprechtHJUrbanP. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation2000; 102: 624–629.
15.
LeonMBBaimDSPopmaJJ. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med1998; 339: 1665–1671.
16.
CutlipDEBaimDSHoKK. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation2001; 103: 1967–1971.
17.
SchuhlenHKastratiAPacheJ. Incidence of thrombotic occlusion and major adverse cardiac events between two and four weeks after coronary stent placement: analysis of 5,678 patients with a four-week ticlopidine regimen. J Am Coll Cardiol2001; 37: 2066–2073.
18.
AlbieroRHallPItohA. Results of a consecutive series of patients receiving only antiplatelet therapy after optimized stent implantation. Comparison of aspirin alone versus combined ticlopidine and aspirin therapy. Circulation1997; 95: 1145–1156.
19.
SchomigANeumannFJKastratiA. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med1996; 334: 1084–1089.
20.
DangasGMehranRAbizaidAS. Combination therapy with aspirin plus clopidogrel versus aspirin plus ticlopidine for prevention of subacute thrombosis after successful native coronary stenting. Am J Cardiol2001; 87: 470–472, A7.
21.
WilsonSHRihalCSBellMR. Timing of coronary stent thrombosis in patients treated with ticlopidine and aspirin. Am J Cardiol1999; 83: 1006–1011.
22.
EPISTENT Investigators. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet1998; 352: 87–92.
23.
EPISTENT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet2000; 356: 2037–2044.
24.
AkkerhuisKMDeckersJWLincoffAM. Risk of stroke associated with abciximab among patients undergoing percutaneous coronary intervention. JAMA2001; 286: 78–82.
