Triage of patients for short term observation after elective coronary angioplasty

Objective-To evaluate triage of patients for short term observation after e lective percutaneous transluminal coronary angioplasty (PTCA), as appropria te selection of patients for short term observation after angioplasty may f acilitate early discharge. Methods-1015 consecutive patients scheduled for elective PTCA were prospect ively included for short term observation. Patients with unstable angina Br aunwald class III were excluded. There were no angiographic exclusion crite ria. Patients were discharged from the interventional centre when considere d stable during 4 hours of observation after PTCA. It was left to the opera tor's discretion whether to prolong the observation period. Procedural comp lications were defined as death, coronary bypass surgery, early repeat PTCA , and myocardial infarction. Outcome measures-The need for prolonged observation (> 4 hours) and the occ urrence of complications. Predictors for prolonged observation and the occu rrence of complications after the 4 hours observation were assessed by univ ariate and multivariate analysis. Results-Two patients died, including one of six patients who underwent emer gency bypass surgery. In all, 922 patients (90.8%) were triaged to short te rm observation and had an uncomplicated three day follow up. Observation wa s prolonged in 87 patients (8.6%), and 40 patients had a complicated course . Independent predictors of procedural complications were acute closure (od ds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlus ion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), f emale sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), a nd ostial lesion (OR 2.2, 1.0 to 4.7). Conclusions-A 4 hour observation period is safe after elective coronary ang ioplasty. As procedural variables are the strongest predictors of postproce dural complications, the immediate procedural results allow effective triag e of patients fur short term or prolonged observation in order to anticipat e complications.