Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era.

J Invasive Cardiol. 2009 May; 21(5): 194-200Good CW, Blankenship JC, Scott TD, Skelding KA, Berger PB, Wood GCBACKGROUND: The frequency of ad hoc percutaneous coronary intervention (PCI) varies among institutions and regions of the country. It is unclear what factors limit use of the ad hoc strategy. OBJECTIVE: To define factors which limit the use of the ad hoc strategy. METHODS: All patients who underwent PCI at our center in 2004 were reviewed. Patients who had emergent PCI for ST-elevation myocardial infarction (n = 188), those who had undergone diagnostic coronary angiography at a referring facility (n = 54), and those who had a repeat PCI after a previous ad hoc PCI (n = 19) were excluded. PCIs performed the same day as diagnostic angiography were considered "ad hoc"; all others were designated "staged". Demographic and procedural factors through hospital discharge were prospectively recorded. Logistic regression analysis was performed to identify correlates of ad hoc PCI, PCI success, and PCI complications. RESULTS: Of the 580 PCI procedures eligible for analysis, 557 (96%) were ad hoc and 23 (4%) were staged. Patients undergoing staged PCI had more lesions treated, a higher rate of no-reflow and periprocedural myocardial infarction, and higher contrast volumes and fluoroscopic times. Logistic regression analysis revealed that patients with history of heart failure, renal insufficiency and a recent myocardial infarction were more likely to undergo a staged PCI. Patients undergoing a staged PCI and those who had previous bypass surgery were more likely to have an unsuccessful PCI procedure. CONCLUSION: Most PCI procedures can be performed safely and effectively on the same day as diagnostic coronary angiography.