Same-day transfer of patients with unstable angina and non-ST segment elevation myocardial infarction back to their referring hospital after angioplasty

Recent evidence has shown the advantages of an early invasive strategy for patients with high-risk unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). However, the number of beds available for postangioplasty monitoring limits the use of this approach at the Centre hospitalier universitaire de Sherbrooke (Fleurimont, Quebec). To study the safety of a protocol allowing the same-day return of patients with UA or NSTEMI to their referring hospital after angioplasty at the Centre hospitalier universitaire de Sherbrooke. From June 2001 to June 2003, of the 532 patients with UA and NSTEMI who underwent percutaneous coronary intervention with planned same-day transfer back to their referring hospital, 419 consecutive patients who were eligible to return the same day were prospectively followed for 24 h. Stents were used in 94.7% of patients and platelet glycoprotein IIb/IIIa receptor antagonists were used in 34.8% of patients. For 85% of patients, the femoral artery was used as the access route for percutaneous coronary intervention. The mean time that patients stayed in the hospital after angioplasty before returning to their referring centres was 4.4 h. No deaths, life-threatening arrhythmias or urgent revascularizations were reported during the 24 h postangioplasty follow-up period, but one patient had a major bleeding complication. During the study period, the mean angioplasty waiting time decreased from 5.7 days to 2.1 days. The protocol evaluated in the present article is safe. It frees more beds, thus reducing the waiting list and allowing patients with high-risk acute coronary syndromes without ST segment elevation from community hospitals to benefit from the advantages of an early invasive strategy. Des études récentes ont montré les bienfaits d’une stratégie d’interventions effractives précoces chez les patients souffrant d’angine de poitrine instable (API) à haut risque ou d’un infarctus du myocarde (IM) sans sus-décalage du segment ST. Toutefois, le nombre de lits disponibles pour la surveillance des patients après une angioplastie limite le recours à cette stratégie au Centre hospitalier universitaire de Sherbrooke (Fleurimont [Québec]). L’étude visait à évaluer l’innocuité d’un protocole de retour, le jour même, de patients souffrant d’API ou d’un IM sans sus-décalage du segment ST à l’hôpital d’origine après une angioplastie pratiquée au Centre hospitalier universitaire de Sherbrooke. De juin 2001 à juin 2003, 532 pati