Triage of patients for short term observation after elective coronary angioplasty
Open Access
- 1 May 2000
- Vol. 83 (5), 557-563
- https://doi.org/10.1136/heart.83.5.557
Abstract
OBJECTIVE To evaluate triage of patients for short term observation after elective percutaneous transluminal coronary angioplasty (PTCA), as appropriate selection of patients for short term observation after angioplasty may facilitate early discharge. METHODS 1015 consecutive patients scheduled for elective PTCA were prospectively included for short term observation. Patients with unstable angina Braunwald class III were excluded. There were no angiographic exclusion criteria. Patients were discharged from the interventional centre when considered stable during 4 hours of observation after PTCA. It was left to the operator's discretion whether to prolong the observation period. Procedural complications were defined as death, coronary bypass surgery, early repeat PTCA, and myocardial infarction. OUTCOME MEASURES The need for prolonged observation (> 4 hours) and the occurrence of complications. Predictors for prolonged observation and the occurrence of complications after the 4 hours observation were assessed by univariate and multivariate analysis. RESULTS Two patients died, including one of six patients who underwent emergency bypass surgery. In all, 922 patients (90.8%) were triaged to short term observation and had an uncomplicated three day follow up. Observation was prolonged in 87 patients (8.6%), and 40 patients had a complicated course. Independent predictors of procedural complications were acute closure (odds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlusion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), female sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), and ostial lesion (OR 2.2, 1.0 to 4.7). CONCLUSIONS A 4 hour observation period is safe after elective coronary angioplasty. As procedural variables are the strongest predictors of postprocedural complications, the immediate procedural results allow effective triage of patients for short term or prolonged observation in order to anticipate complications.Keywords
This publication has 23 references indexed in Scilit:
- Low-Dose Heparin for Routine Coronary Angioplasty and StentingThe American Journal of Cardiology, 1996
- Clinical and lesion morphologic determinants of coronary angioplasty success and complications: Current experienceJournal of the American College of Cardiology, 1995
- Predicting the risk of abrupt vessel closure after angioplasty in an individual patientJournal of the American College of Cardiology, 1994
- Predictors of thrombotic complications after placement of the flexible coil stentThe American Journal of Cardiology, 1994
- Lesion morphology and coronary angioplasty: Current experience and analysisJournal of the American College of Cardiology, 1992
- Abrupt vessel closure complicating coronary angioplasty: Clinical, angiographic and therapeutic profileJournal of the American College of Cardiology, 1992
- Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplastyThe American Journal of Cardiology, 1991
- Clinical and angiographic determinants of primary coronary angioplasty successJournal of the American College of Cardiology, 1991
- Multicenter study of percutaneous transluminal angioplasty for right coronary artery ostial stenosisJournal of the American College of Cardiology, 1987
- Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry.Cell Metabolism, 1983