Transradial PCI and Same Day Discharge
Purpose of review
The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD).
This literature review was performed to evaluate the studies that were published over the last 17 years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: “same day,” “same day discharge,” “outpatient,” and “ambulatory radial PCI.” Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals.
The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.
KeywordsTransradial Radial percutaneous coronary intervention (PCI) Same day discharge Outpatient PCI Same day PCI Ambulatory PCI
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Agostoni P, Biondi-Zoccai GG, de Benedictis ML, Rigattieri S, Turri M, Anselmi M, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349–56. https://doi.org/10.1016/j.jacc.2004.04.034.CrossRefPubMedGoogle Scholar
- 2.Centers for Medicare and Medicaid Services inpatient prospective payment system 1599-F. Fiscal year 2014 final rule. August 19, 2013. Available at: http://www.gpo.gov/fdsys/pkg/FR-2 013–08-19/pdf/2013–18,956.pdf 2014. Accessed Nov. 4, 2017.
- 3.U.S. Department of Health and Human Services, Office of Inspector General. Hospitals’ use of observation stays and short inpatient stays for Medicare beneficiaries. OEI-02-12-00040. July 29, 2013. Available at: http://oig.hhs.gov/oei/reports/oei-02-12-00040.asp. Accessed November 4,2017. Accessed Nov. 4, 2017.
- 5.Jabara R, Gadesam R, Pendyala L, Chronos N, Crisco LV, King SB, et al. Ambulatory discharge after transradial coronary intervention: preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study). Am Heart J. 2008;156(6):1141–6. https://doi.org/10.1016/j.ahj.2008.07.018.CrossRefPubMedGoogle Scholar
- 9.Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomized multicenter trial. Lancet. 2015;385:2465–76. https://doi.org/10.1016/S0140-6736(15)60292-6.CrossRefPubMedGoogle Scholar
- 10.Feldman DM, Swaminathan RV, Kaltenbach LA, Baklanov DV, Kim LK, Wong SC, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention. An Updated Report from the National Cardiovascular Data Registry (2007–2012). Circulation. 2013;127:2295–306. https://doi.org/10.1161/circulationaha.112.000536.CrossRefPubMedGoogle Scholar
- 11.Masoudi FA,Ponirakis A, de Lemos JA, Jollis JG, Kremers M, Messenger JC, et al. Trends in U.S. Cardiovascular Care: 2016 Report from 4 ACC National Cardiovascular Data Registries. doi: https://doi.org/10.1016/j.jacc.2016.12.005
- 12.•• Amin AP, Patterson M, House JA, Giersiefen H, Spertus JA, Baklanov DV, et al. Costs associated with access site and same-day discharge among Medicare beneficiaries undergoing percutaneous coronary intervention: an evaluation of the current percutaneous coronary intervention care pathways in the United States. J Am Coll Cardiol Intv. 2017;10:342–51. https://doi.org/10.1016/j.jcin.2016.11.049. The financial analysis evaluating the difference between standard femoral overnight stay and same day radial PCI demonstrates the incredible cost savings that can be incurred by changing our current practice patter.CrossRefGoogle Scholar
- 15.Brodie B, Pokharel Y, Garg A, Kissling G, Hansen C, Milks S, et al. Predictors of early, late, and very late stent thrombosis after primary percutaneous coronary intervention with bare-metal and drug-eluting stents for ST-segment elevation myocardial infarction. J Am Coll Cardiol Intv. 2012;5:1043–51. https://doi.org/10.1016/j.jcin.2012.06.013.CrossRefGoogle Scholar
- 16.Dangas GD, Caixeta A, Mehran R, Parise H, Lansky AJ, Cristea E, et al. Frequency and predictors of stent thrombosis after percutaneous coronary intervention in acute myocardial infarction for the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial Investigators. Circulation. 2011;123:1745–56. https://doi.org/10.1161/circulationaha.110.981688.CrossRefPubMedGoogle Scholar
- 17.• Gilchrist IC, Rhodes DA, Zimmerman HE. A single center experience with same-day transradial-PCI patients: a contrast with published guidelines. Catheter Cardiovasc Interv. 2012;79(4):583–7. https://doi.org/10.1002/ccd.23159. This small but important single center series highlights the variability in patients that are acceptable for same day discharge.CrossRefPubMedGoogle Scholar
- 23.Small A, Klinke P, Della Siega A, Fretz E, Kinloch D, Mildenberger R, et al. Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study. Catheter Cardiovasc Interv. 2007;70:907–12. https://doi.org/10.1002/ccd.21277.CrossRefPubMedGoogle Scholar
- 27.Shah SF, Shah I, Jan H, et al. Utility of transradial coronary angioplastyin patients with chronic stable angina discharged on same day. J Postgrad Med Inst. 2012;26:138–43.Google Scholar
- 32.Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409–20. https://doi.org/10.1016/S0140-6736(11)60404-2.CrossRefPubMedGoogle Scholar
- 33.Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60:2481–9. https://doi.org/10.1016/j.jacc.2012.06.017.CrossRefPubMedGoogle Scholar
- 35.Sarno G, Lagerqvist B, Carlsson J, Olivecrona G, Nilsson J, Calais F, et al. Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). International Journal of Cardiology. 2013;167:146–50. https://doi.org/10.1016/j.ijcard.2011.12.057.CrossRefPubMedGoogle Scholar
- 36.Brodie BR, Garg A, Stuckey TD, Kirtane AJ, Witzenbichler B, Maehara A, et al. Fixed and modifiable correlates of drug-eluting stent thrombosis from a large All-Comers Registry Insights From ADAPT-DES. Circ Cardiovasc Interv. 2015;8:e002568. https://doi.org/10.1161/circinterventions.114.002568.CrossRefPubMedGoogle Scholar
- 38.• Chambers CE, Dehmer GJ, Cox DA, Harrington RA, Babb JD, Popma JJ, et al. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Endorsed by the American College of Cardiology Foundation Catheter. Cardiovasc Interv. 2009;73:847–58. https://doi.org/10.1002/ccd.22100. An important consensus document highlighting the factors necessary to determine appropriate lengths of stay for patients.Google Scholar
- 42.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:e574–651. https://doi.org/10.1161/CIR.0b013e31823ba622.CrossRefPubMedGoogle Scholar