Transradial Percutaneous Coronary Intervention for Acute Myocardial Infarction Reduces CCU Stay in Patients 80 or Older

Abstract

SummaryTransradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 ± 1.5 days and 5.0 ± 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 ± 7.4 days and 19.2 ± 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 ± 0.7 and 4.6 ± 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (≤ 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients ≥ 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population. (Int Heart J 2012; 53: 79-84) Key words: Acute myocardial infarction, Percutaneous coronary intervention, Transradial approach, Elderly T he transradial approach has become an option in current percutaneous coronary interventions (PCI). 1-3) Compared with transfemoral PCI, transradial PCI is a less invasive procedure with fewer bleeding complications.2-9) Recently, the transradial approach has been used for patients who require emergent PCI. [10][11][12][13] Since the transradial approach does not require complete bed rest, transradial PCI may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). 5,8,9,[14][15][16] Elderly patients, especially those ≥ 80 years old, have an elevated risk of complications in the ICU or CCU setting. [17][18][19] Avoiding a prolonged CCU stay and early rehabilitation should be beneficial for this high risk population. Therefore, elderly AMI patients ≥ 80 years old may be suitable candidates for transradial PCI. We hypothesized that transradial PCI would shorten the CCU stay in very elderly AMI patients compared with a transfemoral or transbrachial approach. The aim of our study was to investigate whether transradial PCI is associated with a shorter CCU stay in AMI patients ≥ 80 years old. MethodsPatients: A retrospective review of medical records identified patients who met the following criteria: (1) persistent chest pain, elevation of creatine kinase (at least 2-fold above the normal upper limit)...

Clinical outcomes after acute myocardial infarction according to a novel stratification system linked to a rehabilitation program

“…The length of hospital stay varies widely among countries, partly because of socioeconomic reasons. As compared to Western countries [16], the length of hospital stay in AMI was longer in Japan [12,25], which may reflect the inexpensive copayments in the Japanese health insurance system [26]. The current Japanese guideline recommends a 14-day rehabilitation program, including 200-m walk and 500-m walk tests, even for Killip class I AMI patients with successful reperfusion therapy [27].…”

Coronary Stenting in the Elderly: Current Status and Future Developments

“…Additionally, there were reduced rates of access site bleeding (2.7% vs. 9.6%, p = 0.004), hematoma (4.5% vs. 10.9%, p = 0.006), or any vascular complication (7.1% vs. 23.7%, p < 0.001) with the radial approach as opposed to femoral [15]. Additionally, radial access is associated with reduced ambulation time, shorter CCU stays (3.6 ± 1.5 vs. 5.0 ± 3.2 days, p = 0.001), and even reduced duration of hospitalization (13.3 ± 7.4 days vs. 19.2 ± 11.1 days, p = 0.001) compared to femoral access in AMI patients > 80 years old [17,19].…”