Formal Multicentric Ambulatory Coronary Angioplasty (ACA III) program

Telayna, Juan Manuel

Background
Coronary angioplasty has become safe and predictable in terms of acute coronary occlusion and vascular complications. In 2009 we started at Hospital Austral with a formal same day discharge (SDD) program (ACA I) in low clinical and angiographic risk pts undergoing PCI. We went on with program ACA II, including both higher clinical and angio risk pts, with great results. Our next step is external validity evaluation. Objective: Evaluate feasibility and safety of a formal program of ambulatory coronary angioplasty in pts with low clinical and angiographic risk, replicating our results in different hospitals in Argentina (ACA III)

Methods:
From March 2015 to Nov 2018, 232 SDD PCI were performed at five centers in Argentina: H. Austral, H. Priv U de Córdoba; Instituto Garat, I. Cardiovascular de Corrientes & I. de Cardiología de Tucumán). Inclusion: 1 Positive Allen test; 2 stable angina; 3 unstable angina (Br I-II); 4 silent ischemia; 5 written consent; 6 procedure ended before 4 pm; 7 EF ≥50%; 8 adult at home w/ close access to hospital; 9 absence of EKG changes; 10 successful uncomplicated procedure without the occurrence of: no reflow, acute vessel closure, disesection, compromised side branch flow; 11 PCI with stent; 12 painless after PCI; 13 no access complications. Exclusion: 1 AMI; 2 unstable angina (UA) -III- 3 cardio shock; 4 ACS as epiphenomenon; 5 treatment of only patent vessel; 6 UPLM; 7 type C lesion; 8 Bifurcation. Patients meeting inclusion criteria remained in hospital observation for 4 hs. Baseline: age 62±8; male 198 (85%); diabetes 62 (27); hypertension 178 (77); smoker 102 (44); prior CABG 7 (3); prior PCI 93 (40); prior AMI 64 (28); EF avg 59±7%; stable angina 92 (40); UA 57 (25); silent ischemia 81 (35); MVD 88 (38), LAD 121 (52); right radial 228 (98); 6 F 223 (96); 7 F 6 (3); 8 F 2 (1); stents n°avg 1.6±1; all DES 215 (93); stents in mm 36.3±23.9; IVUS 14 (6); contrast 142.4±61.5; fluoro 11.8±14.2

Results:
Technical success 232 (100); Clinical success 232 (100), early coronary occlusion 0; hospital mortality 0; vascular complication 0. No reinterventions at 30 days.

Conclusions:
It is feasible and safe to indicate SDD after low clinical and angiographic risk PCI, replicating the results in other centers throughout the country.