Skip to main content
PMC home page
Heart logoLink to Heart
. 2000 May;83(5):557–563. doi: 10.1136/heart.83.5.557

Triage of patients for short term observation after elective coronary angioplasty

K Koch 1, J Piek 1, M Prins 1, R J de Winter 1, K Mulder 1, K Lie 1, J Tijssen 1
PMCID: PMC1760812  PMID: 10768908

Abstract

OBJECTIVE—To evaluate triage of patients for short term observation after elective percutaneous transluminal coronary angioplasty (PTCA), as appropriate selection of patients for short term observation after angioplasty may facilitate early discharge.
METHODS—1015 consecutive patients scheduled for elective PTCA were prospectively included for short term observation. Patients with unstable angina Braunwald class III were excluded. There were no angiographic exclusion criteria. Patients were discharged from the interventional centre when considered stable during 4 hours of observation after PTCA. It was left to the operator's discretion whether to prolong the observation period. Procedural complications were defined as death, coronary bypass surgery, early repeat PTCA, and myocardial infarction.
OUTCOME MEASURES—The need for prolonged observation (> 4 hours) and the occurrence of complications. Predictors for prolonged observation and the occurrence of complications after the 4 hours observation were assessed by univariate and multivariate analysis.
RESULTS—Two patients died, including one of six patients who underwent emergency bypass surgery. In all, 922 patients (90.8%) were triaged to short term observation and had an uncomplicated three day follow up. Observation was prolonged in 87 patients (8.6%), and 40 patients had a complicated course. Independent predictors of procedural complications were acute closure (odds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlusion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), female sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), and ostial lesion (OR 2.2, 1.0 to 4.7).
CONCLUSIONS—A 4 hour observation period is safe after elective coronary angioplasty. As procedural variables are the strongest predictors of postprocedural complications, the immediate procedural results allow effective triage of patients for short term or prolonged observation in order to anticipate complications.


Keywords: angioplasty; triage; interventional cardiology

Full Text

The Full Text of this article is available as a PDF (126.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agrawal S. K., Ho D. S., Liu M. W., Iyer S., Hearn J. A., Cannon A. D., Macander P. J., Dean L. S., Baxley W. A., Roubin G. S. Predictors of thrombotic complications after placement of the flexible coil stent. Am J Cardiol. 1994 Jun 15;73(16):1216–1219. doi: 10.1016/0002-9149(94)90186-4. [DOI] [PubMed] [Google Scholar]
  2. Black A. J., Namay D. L., Niederman A. L., Lembo N. J., Roubin G. S., Douglas J. S., Jr, King S. B., 3rd Tear or dissection after coronary angioplasty. Morphologic correlates of an ischemic complication. Circulation. 1989 May;79(5):1035–1042. doi: 10.1161/01.cir.79.5.1035. [DOI] [PubMed] [Google Scholar]
  3. Budde T., Haude M., Höpp H. W., Kerber S., Caspari G., Fassbender G., Fingerhut M., Novopashenny I., Breithardt G., Erbel R. A prognostic computer model to predict individual outcome in interventional cardiology. The INTERVENT Project. Eur Heart J. 1997 Oct;18(10):1611–1619. doi: 10.1093/oxfordjournals.eurheartj.a015141. [DOI] [PubMed] [Google Scholar]
  4. Detre K. M., Holmes D. R., Jr, Holubkov R., Cowley M. J., Bourassa M. G., Faxon D. P., Dorros G. R., Bentivoglio L. G., Kent K. M., Myler R. K. Incidence and consequences of periprocedural occlusion. The 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1990 Sep;82(3):739–750. doi: 10.1161/01.cir.82.3.739. [DOI] [PubMed] [Google Scholar]
  5. Dimas A. P., Grigera F., Arora R. R., Simpfendorfer C. C., Hollman J. L., Frierson J. H., Franco I., Whitlow P. L. Repeat coronary angioplasty as treatment for restenosis. J Am Coll Cardiol. 1992 May;19(6):1310–1314. doi: 10.1016/0735-1097(92)90339-o. [DOI] [PubMed] [Google Scholar]
  6. Dorros G., Cowley M. J., Simpson J., Bentivoglio L. G., Block P. C., Bourassa M., Detre K., Gosselin A. J., Grüntzig A. R., Kelsey S. F. Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry. Circulation. 1983 Apr;67(4):723–730. doi: 10.1161/01.cir.67.4.723. [DOI] [PubMed] [Google Scholar]
  7. Ellis S. G., Miller D. P., Brown K. J., Omoigui N., Howell G. L., Kutner M., Topol E. J. In-hospital cost of percutaneous coronary revascularization. Critical determinants and implications. Circulation. 1995 Aug 15;92(4):741–747. doi: 10.1161/01.cir.92.4.741. [DOI] [PubMed] [Google Scholar]
  8. Ellis S. G., Roubin G. S., King S. B., 3rd, Douglas J. S., Jr, Weintraub W. S., Thomas R. G., Cox W. R. Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation. 1988 Feb;77(2):372–379. doi: 10.1161/01.cir.77.2.372. [DOI] [PubMed] [Google Scholar]
  9. Ellis S. G., Vandormael M. G., Cowley M. J., DiSciascio G., Deligonul U., Topol E. J., Bulle T. M. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990 Oct;82(4):1193–1202. doi: 10.1161/01.cir.82.4.1193. [DOI] [PubMed] [Google Scholar]
  10. Huber M. S., Mooney J. F., Madison J., Mooney M. R. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol. 1991 Aug 15;68(5):467–471. doi: 10.1016/0002-9149(91)90780-o. [DOI] [PubMed] [Google Scholar]
  11. Kiemeneij F., Laarman G. J., Odekerken D., Slagboom T., van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol. 1997 May;29(6):1269–1275. doi: 10.1016/s0735-1097(97)00064-8. [DOI] [PubMed] [Google Scholar]
  12. Koch K. T., Piek J. J., de Winter R. J., David G. K., Mulder K., Tijssen J. G., Lie K. I. Safety of low dose heparin in elective coronary angioplasty. Heart. 1997 Jun;77(6):517–522. doi: 10.1136/hrt.77.6.517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lincoff A. M., Popma J. J., Ellis S. G., Hacker J. A., Topol E. J. Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol. 1992 Apr;19(5):926–935. doi: 10.1016/0735-1097(92)90272-o. [DOI] [PubMed] [Google Scholar]
  14. Myler R. K., Shaw R. E., Stertzer S. H., Hecht H. S., Ryan C., Rosenblum J., Cumberland D. C., Murphy M. C., Hansell H. N., Hidalgo B. Lesion morphology and coronary angioplasty: current experience and analysis. J Am Coll Cardiol. 1992 Jun;19(7):1641–1652. doi: 10.1016/0735-1097(92)90631-v. [DOI] [PubMed] [Google Scholar]
  15. Savage M. P., Goldberg S., Hirshfeld J. W., Bass T. A., MacDonald R. G., Margolis J. R., Taussig A. S., Vetrovec G., Whitworth H. B., Zalewski A. Clinical and angiographic determinants of primary coronary angioplasty success. M-HEART Investigators. J Am Coll Cardiol. 1991 Jan;17(1):22–28. doi: 10.1016/0735-1097(91)90700-j. [DOI] [PubMed] [Google Scholar]
  16. Steffenino G., Meier B., Finci L., Velebit V., von Segesser L., Faidutti B., Rutishauser W. Acute complications of elective coronary angioplasty: a review of 500 consecutive procedures. Br Heart J. 1988 Feb;59(2):151–158. doi: 10.1136/hrt.59.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tan K., Sulke N., Taub N., Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol. 1995 Mar 15;25(4):855–865. doi: 10.1016/0735-1097(94)00462-Y. [DOI] [PubMed] [Google Scholar]
  18. Tenaglia A. N., Fortin D. F., Califf R. M., Frid D. J., Nelson C. L., Gardner L., Miller M., Navetta F. I., Smith J. E., Tcheng J. E. Predicting the risk of abrupt vessel closure after angioplasty in an individual patient. J Am Coll Cardiol. 1994 Oct;24(4):1004–1011. doi: 10.1016/0735-1097(94)90862-1. [DOI] [PubMed] [Google Scholar]
  19. Topol E. J., Ellis S. G., Fishman J., Leimgruber P., Myler R. K., Stertzer S. H., O'Neill W. W., Douglas J. S., Roubin G. S., King S. B., 3rd Multicenter study of percutaneous transluminal angioplasty for right coronary artery ostial stenosis. J Am Coll Cardiol. 1987 Jun;9(6):1214–1218. doi: 10.1016/s0735-1097(87)80458-8. [DOI] [PubMed] [Google Scholar]
  20. Vainer J., Fleisch M., Gunnes P., Ramamurthy S., Garachemani A., Kaufmann U. P., Meyer B. J., Lüscher T. F., Meier B. Low-dose heparin for routine coronary angioplasty and stenting. Am J Cardiol. 1996 Oct 15;78(8):964–966. doi: 10.1016/s0002-9149(96)00480-8. [DOI] [PubMed] [Google Scholar]
  21. de Feyter P. J., van den Brand M., Laarman G. J., van Domburg R., Serruys P. W., Suryapranata H., Jaarman G. Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up. Circulation. 1991 Mar;83(3):927–936. doi: 10.1161/01.cir.83.3.927. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES