Olcay A.,TDV 29 Mayis Istanbul Hospital |
Cakmak H.A.,Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center |
Bigmurad T.O.,Istanbul University |
Eren F.,TDV 29 Mayis Istanbul Hospital |
And 4 more authors.
Experimental and Clinical Cardiology | Year: 2014
Background: In the era of coronary stenting, ad hoc percutaneous coronary intervention (PCI) can reduce both the length and the cost of hospital stay in patients with stable or unstable coronary artery disease. However, it raises some concerns regarding ethical issues, informed decision making, thrombocyte inhibition, reduced or increased cost, patient anxiety and safety issues in some elective cases. PCI, which is performed on the same day as diagnostic angiography were considered as "ad hoc"; but all the others were designated "staged". Objective: In our study, in order to overcome all these concerns due to ad-hoc PCI, we investigated the effects of following protocol termed as the "slow ad-hoc PCI strategy" on coronary vessels diameters and flow in patient with stable coronary artery disease who underwent elective PCI procedure. Methods: We retrospectively analyzed in-hospital clinical, pre-procedural, peri-procedural and postprocedural angiographic results of 111 slow ad-hoc PCI patients performed by one experienced interventional cardiologist between April 2007-February 2012. In slow ad-hoc PCI protocol, patients are hospitalized at 7:30 AM and diagnostic coronary angiographies were performed in the morning. After diagnostic angiography, patients who require PCI were given slow ad-hoc drug coctail and patient was sent to the room for discussing the results with family and heart team. If patient accepts PCI, procedure was performed in the afternoon after about 4-5 hours later of diagnostic angiography. Results: In this study, 111 patients were enrolled and 125 vessel interventions were performed. While coronary artery diameters were significantly larger in diagnostic angiography than pre-PCI (2.80±0.59 mm vs 2.65±0.60 mm, p=0.01 respectively), there was no difference between diagnostic angiography and post-PCI in terms of these diameters (2.80±0.59 vs 2.86±0.47, p= 0.17). Also, coronary vessel diameters in pre-PCI group were significantly smaller than post-PCI group (2.65±0.6 vs 2.86±0.47, p=0.0001). There was no difference between diagnostic and pre-PCI groups in terms of percentage of stenosis (80.94±7.28% vs 81.06±8.1%, p= 0.86). CTFCs in diagnostic angiography group (27.29±6.1) were found to be significantly higher than pre-PCI (26.94±6.16) and post-PCI (25.73±5.89). Conclusion: Although slow ad-hoc PCI provides no advantage in terms of coronary vessel diameters, percentage of stenosis as compared at diagnostic and pre-PCI angiography, it provides lower CTFC and may give a patient adequate time for thoughtful decision-making.