The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions.

BACKGROUND: The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS: Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS: Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS: The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.

Seguridad y factibilidad de la intervención coronaria percutánea ambulatoria en pacientes seleccionados: datos de un registro multicéntrico español / Safety and feasibility of outpatient percutaneous coronary intervention in selected patients: a Spanish multicenter registry

Introducción y objetivos: El aumento exponencial de la intervención coronaria y la generalización del acceso radial son el escenario ideal para iniciar programas de angioplastia ambulatoria con el objetivo de disminuir ocupación y reducir el coste manteniendo la seguridad. Se presentan por primera vez datos de un registro multicéntrico español sobre angioplastia transradial ambulatoria en pacientes seleccionados. Métodos: Registro prospectivo de angioplastia ambulatoria electiva con acceso radial-cubital en pacientes con cardiopatía isquémica estable. Los pacientes eran dados de alta el mismo día y se realizó seguimiento a las 24 h y a los 30 días. Se analizan la seguridad y la factibilidad. Resultados: De un total de 723 pacientes incluidos (el 76% varones; edad, 66,6 ± 10,5 años), a 533 (73,7%) se les dio finalmente el alta tras 4-12 h de vigilancia. El motivo más frecuente de ingreso entre los 190 (26,7%) restantes fue inestabilidad clínica tras el procedimiento (60,5%). El antecedente de arteriopatía periférica, un valor de creatinina basal más elevado, la realización del procedimiento ad hoc y sobre enfermedad multivaso fueron predictores independientes de ingreso. A las 24 h se registró un evento adverso mayor (0,19%) en 1 paciente que necesitó ingreso por hemorragia mayor no relacionada con el acceso vascular. A los 30 días se registraron 3 eventos mayores (0,56%), 1 trombosis subaguda de stent, 1 revascularización sobre un vaso diferente del tratado y 1 ictus minor. A los 30 días habían necesitado ingreso 8 pacientes (1,5%). Conclusiones: La aplicación de un programa de angioplastia ambulatoria transradial-cubital con alta tras 4-12 h de vigilancia es factible y segura en pacientes apropiadamente seleccionados (AU)

Introduction and objectives: The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. Methods: Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24 hours and 30 days. Safety and feasibility were analyzed. Results: Of the 723 patients included (76% male; age, 66.6 ± 10.5 years), 533 (73.7%) were finally discharged after 4 to 12 hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24 hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. Conclusions: The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours’ surveillance is safe and feasible in well-selected patients (AU)

Safety and Feasibility of Outpatient Percutaneous Coronary Intervention in Selected Patients: A Spanish Multicenter Registry.

INTRODUCTION AND OBJECTIVES: The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. METHODS: Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. RESULTS: Of the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. CONCLUSIONS: The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours' surveillance is safe and feasible in well-selected patients.

A propósito de la desensibilización rápida al ácido acetilsalicílico de pacientes con cardiopatía isquémica. Respuesta / About rapid aspirin desensitization in coronary artery disease patients. Response

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Desensibilización rápida al ácido acetilsalicílico de pacientes con cardiopatía isquémica: experiencia de un centro / Rapid desensitization to aspirin in patients with coronary artery disease: A single center experience

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Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome.

INTRODUCTION AND OBJECTIVES: Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. RESULTS: Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024). CONCLUSIONS: PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events.

La reactividad plaquetaria post-tratamiento predice los eventos adversos a largo plazo mejor que la respuesta al clopidogrel en pacientes con síndrome coronario agudo sin elevación del ST / No disponible

Introducción y objetivos. Una peor respuesta al tratamiento antiagregante está relacionada con la recurrencia de eventos clínicos. El objetivo de este estudio es valorar la relación entre la respuesta al clopidogrel y la reactividad plaquetaria post-tratamiento (RPP) con la recurrencia de eventos adversos cardiovasculares a 1 año en pacientes con síndrome coronario agudo sin elevación del ST (SCASEST). Métodos. Estudio observacional, prospectivo de la respuesta al clopidogrel y RPP (analizador VerifyNow®) inmediatamente antes de la coronariografía diagnóstica. Resultados. De 179 pacientes incluidos (97 con intervencionismo coronario y 21 con cirugía coronaria), 161 (90%) completaron seguimiento a 1 año y 18 (11%) sufrieron eventos: 10 muertes, 6 infartos agudos de miocardio no fatales, 2 accidentes cerebrovasculares y 5 nuevas revascularizaciones. Una peor respuesta al clopidogrel (31% ± 21% frente a 43% ± 21%; p = 0,049) y una mayor RPP (204 ± 60 frente a 155 ± 67 unidades de reactividad plaquetaria [URP]; p = 0,006) se asociaron significativamente con la aparición de eventos. El análisis multivariable confirmó la RPP (odds ratio [OR] por incremento de 10 URP = 1,12; intervalo de confianza [IC] del 95%, 1,01-1,24; p = 0,020) como predictor independiente de eventos adversos cardiovasculares mayores. Un punto de corte de RRP de 175 URP se asoció con OR ajustada = 3,9 (IC del 95%, 1,2-15,4; p = 0,024) para la aparición de eventos. Conclusiones. La RPP predice la aparición de eventos adversos a largo plazo mejor que la respuesta al clopidogrel en pacientes con SCASEST. Los pacientes con valores de RPP > 175 URP presentan mayor riesgo de sufrir eventos adversos

Introduction and objectives: Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow® analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. Results: Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 ± 21% vs. 43 ± 21%; P.049) and higher PPR (204 ± 60 vs. 155 ± 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024). Conclusions: PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events