SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

Abstract

Coronary intervention may be combined with diagnostic cardiac catheterization or performed separately. In the early years of angioplasty, performing these procedures separately was standard practice. Gradually, ad hoc intervention (performing diagnostic angiography and coronary intervention within the same session) has become more common, largely because of its convenience for patients and efficiency for physicians. However, the safety and potential cost savings of this approach remain uncertain. Criteria for the appropriate use of ad hoc intervention have not been established. Ad hoc intervention is reasonable for many, but not appropriate for all patients and should not be considered standard therapy. This document updates an earlier review of this topic and provides suggestions for the use of ad hoc intervention as a routine strategy. Catheter

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…When informed consent for PCI is obtained before diagnostic catheterization is performed, it is impossible to predict the levels of risk and benefit from an ad hoc PCI. 310,311 If diagnostic catheterization reveals anatomy that poses a particularly high risk or for which the superiority of PCI compared with other strategies is unclear, the precatheterization informed consent discussion may be inadequate. In such cases, deferral of PCI until additional informed consent discussions and/or consultations occur may be appropriate, even though it inconveniences the patient and the healthcare system.…”

“…When considering whether to perform multivessel PCI in 1 stage versus 2 stages, safety and convenience for the patient must guide the decision, regardless of payment policies that maximize reimbursement when PCI is staged. 311 A separate issue is self-referral, through which diagnostic catheterization often leads seamlessly to PCI by the same operator. 315 The interventionist has an ethical obligation to the patient to consider all treatment options, consult with additional specialists (eg, cardiac surgeons) when their input would be helpful to the patient, avoid unnecessary interventional procedures, and allow the patient to consult family members and other physicians.…”

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

“…This is the most convenient for patients, and compared with a staged strategy, it is much preferred by patients. However, when ad hoc PCI is multivessel, there are special risks to consider [88,89]. First, contrast and radiation used during the diagnostic catheterization may limit the additional doses that can be used during PCI.…”

“…For the patient to be able to make a deliberate informed decision, termination of the procedure after diagnostic catheterization may be appropriate [88,89].…”

Defining the length of stay following percutaneous coronary intervention

“…Elective PCI refers to coronary revascularization in a low-risk, stable patient who presents to a facility from home for a planned PCI or a coronary angiogram with PCI to follow if appropriate (so-called ad hoc PCI) [2]. When PCI is performed in a patient who is admitted to the hospital for ST-segment elevation myocardial infarction (STEMI), non-STEMI, or an acute coronary syndrome with evidence of myocardial ischemia, it is not considered an elective PCI procedure.…”