Recent improvements in results of PCI have made ad hoc PCI an attractive treatment approach. Ad hoc PCI reduces the length of hospital stay and change-over time in the cath lab between diagnostic angiography and PCI, lessens the chance of access site complications from repeat procedures, and for pts from outside the procedure hospital (PH) eliminates the cost of another transfer to PH for PCI. However, availability of beds for post-PCI recovery at PH has often been the limiting factor to ad hoc PCIs. The Royal Alexandra Hospital, a PH, in partnership with 3 hospitals without cath labs (NCCH), has adopted an ad hoc PCI and same day return approach for since the 1990s. We analyzed the results in pts who were returned to the referring hospital for post PCI recovery in 2002.

PCI was performed on 244 lesions in 213 pts (age 64±12, 77% male, 97.2% CCS Class 4, 95.3% ad hoc PCI, 82.6% radial approach). Pts were categorized as emergency 2.8%, urgent in-pt 94.8%, urgent out-pt 1.4%; with diagnoses of unstable angina 24.4%, NSTEMI 34.3%, STEMI 37.6%. PCI was performed in LAD 33.6%, LCx 19.7%, RCA 40.6%, Ramus 1.6%, Diagonal 2.9%, SVG 1.6%. Lesion complexity was C 32.4%, B2 44.7%, B1 17.2%, A 5.3%. Platelet IIbIIIa inhibitor was used in 54.9% and stents in 90.6% of PCIs. PCI success rate was 95.3%. Post-PCI complications include NSTEMI (CK >3x ULN, no new ST elevation) in 4 pts (1.9%) and access site haematoma in 2 pts (0.9%). No pt was referred back to PH for complications and there was no emergency repeat PCI, bypass surgery or death within 24 hrs of PCI.

Our results showed that the approach of ad hoc PCI and same day return to NCCH has a high success rate and excellent safety record. This should be considered as the standard approach for urgent in-pts from NCCH who may require PCIs.

DNC

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