Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern New England and comparison with similar procedures performed later

"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immedia tely after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of on ad hoc strategy in a large reg ional population to determine its use and outcomes campared with staged pro cedures. A database from the 6 centers performing PCIs in northern New Engl and and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 P CIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patient s having ad hoc procedures were less likely to have peripheral vascular dis ease, renal failure, prior myocardial infarction, or coronary artery by-pas s surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitrogly cerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein gra fts. Adjusted rates of clinical success were not different between ad hoc a nd non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the i ncidence of death (0.6% vs 0.5%), emergency (0.9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infraction (2.6% vs 2.0 %). As currently practiced in our region, ad hoc intervention is used selec tively with outcomes similar for ad hoc and non-ad hoc procedures. (C) 2000 by Excerpta Medica, Inc.