Chapter 31: Discharge Instructions/Radial Lounge

There is a growing trend for outpatient discharge following percutaneous coronary intervention (PCI). The early ambulation and essential absence of access site complications associated with transradial PCI (TRI) make this approach ideal for the ambulatory strategy. The most commonly cited reasons for overnight admission include surveillance for access site complications, periprocedural events, and abrupt target vessel closure. In today’s advanced PCI arena, the latter two complications have become exceedingly rare. Nonetheless, when they do occur, these unusual events are almost always evident within 6 hours, if not apparent intra-procedurally; and the risk precipitously declines thereafter. The rare but potentially catastrophic complication of subacute stent thrombosis typically occurs 3 to 5 days post-procedurally and would therefore be unaltered by choice of discharge strategy. The remaining concern of access site complications is all but eliminated by the transradial approach, thereby making it ideal for consideration of sameday PCI. We previously reported on the potential feasibility and safety of an outpatient TRI discharge strategy. Among multiple other studies, promising data from a recent meta-analysis involving 13 studies and over 111,000 patients further reinforced this concept.

Jack P. Chen, MD, FACC, FSCAI, FCCP and James Wood Tyson