Author + information
- Peter Moore1,
- Navin Chandra2,
- Imad Nadra1,
- Simon Robinson1,
- Eric Fretz3,
- Lilian Ding4,
- Sean Hardiman4,
- Anthony Fung5,
- Eve Aymong6,
- Albert Chan7,
- Steven Hodge8,
- David Wood9,
- Anthony Della Siega1 and
- Bilal Iqbal1
- 1Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 2Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 3Royal Jubilee Hospital, victoria, British Columbia, Canada
- 4Provincial Health Services Authority, Vancouver, British Columbia, Canada
- 5Vancouver General Hospital, Vancouver, British Columbia, Canada
- 6St. Paul's Hospital, Vancouver, British Columbia, Canada
- 7Royal Columbian Hospital, new westminster, British Columbia, Canada
- 8Kelowna General Hospital, Winnipeg, British Columbia, Canada
- 9Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
Patients having culprit vessel intervention at primary percutaneous coronary intervention (PCI) may undergo staged PCI of non-culprit disease. Whether this is performed as an inpatient (IP) or outpatient (OP) requires balancing of the risks of PCI in the vulnerable peri-infarct period versus ischemic complications from untreated disease. We sought to determine if there was an optimal timeframe for staged OP PCI.
A decision model was used to compare staged IP vs. OP PCI at “N” days following discharge. We modelled adjusted mortality to create probability distribution functions of “N” using data from 15,464 patients from the British Columbia Cardiac Registry. We used sensitivity analyses (N:1-90) to compare 1-year mortality for both strategies and determine NS – the number of days after discharge where a staged OP strategy would be better than an IP strategy.
A total of 658 STEACS patients had staged IP PCI and their 1-year mortality rate was 4.3%. Sensitivity analyses indicated that NS values were 63 days, 51 days and 73 days for non-culprit LAD, LCX and RCA disease respectively. For patients with one non-culprit vessel, the NS was 49 days (figure 1A), and for two non-culprit vessels, the NS was 10 days (figure 1B).
For patients with STEACS and one non-culprit vessel, a strategy of OP staged PCI may be beneficial if performed in the first 49 days after discharge. For two vessel non-culprit disease, OP staged PCI may be beneficial within the first 10 days after discharge, and could be considered for staged PCI prior to discharge.
CORONARY: Acute Myocardial Infarction