BACKGROUND: Advances in methodologies applied in PTCA (Percutaneous Transluminal Coronary Angioplasty) have led to a reduction in the risk of perioperative and post-procedural complications, such as the use of drug-eluting stents (DES) and the more frequent use of the radial artery as an access site, contributing over the years to an increase in procedures performed on a day hospital basis.OBJECTIVE: To monitor clinical outcomes and adverse events related to the procedure, allowing the measurement of the appropriateness of the clinical pathway for patients undergoing brief hospitalization, during coronary angiography, for coronary angioplasty with at least 24 hours of extended observation in regular hospitalization after the procedure.MATERIALS AND METHODS: This descriptive study examines PTCA procedures conducted on a day hospital basis in the years 2021 and 2022. Data were retrieved from the Suitestensa® hemodynamic database of the AST of Ascoli Piceno, and the following items were assessed: bioclinical aspects related to the procedure and risk factors, procedural outcomes, and the access site used; complications observed during the intervention and in the post-procedure monitoring phase, as well as the average length of stay. Clinical outcomes evaluated during the follow-up period were also analyzed.RESULTS: In a sample of 135 patients, 78.52% (n=106) were male, and 21.48% (n=29) were female; the average age was 69.43. In 30.37% (n=41) of cases, there was a diagnosis of single-vessel coronary artery disease, 28.15% (n=38) had two-vessel disease, 25.19% (n=34) had three-vessel disease, and 6.67% (n=9) presented with left main coronary artery disease. In total, 17.04% (n=23) had a prior acute myocardial infarction (AMI), and 47.41% (n=64) had previously undergone a PTCA, with only 5.19% (n=7) having a history of aortocoronary bypass surgery. 80% (n=108) underwent single-vessel PTCA, while 20% (n=27) had multi-vessel angioplasty, with an effectiveness rate of 97.78% in 132 cases, and ineffectiveness noted in 2.22% (n=3). The most significant risk factors included hypertension at 69.63% (n=94), dyslipidemia at 39.26% (n=53).The most frequently used access site was the radial access at 92.59% (n=125), with femoral access in 6 cases (4.44%). The average length of stay was ±2.27 days. A single complication related to the access site was reported; complications related to the procedure were observed in 0.74% (n=1) of cases. During the follow-up period, 103 patients were assessed, with 76.30% having a first outpatient visit; 84 patients also had a second visit, with 62.22%. 94.17% (n=97) and 88.10% (n=74) of the assessed patients had no major cardiovascular events (MACE). ANALYSIS: Data analysis was performed using Microsoft Excel®; descriptive statistics and variables were represented by frequency (N.) and corresponding percentage (%), organized in tables and with the use of graphs.DISCUSSION AND CONCLUSIONS: the treatment's effectiveness is highly significant. A large number of patients underwent radial access and effective hemostasis, supported by the use of high-performance devices. The reduction in major cardiovascular events post PTCA with brief hospitalization was made possible through appropriate patient selection according to clinical risk stratification. Quality measures are defined by structural elements, the use of shared diagnostic-therapeutic protocols within a multidisciplinary framework, aimed at optimizing hospital activity and improving the management of complications.Keywords: Coronary angioplasty, clinical outcomes, day hospital.
INTRODUZIONE: i progressi nelle metodologie applicate nella PTCA (angioplastica coronarica transluminale percutanea) hanno permesso una riduzione del rischio di complicanze peri e post procedurali, come l’impiego di stent a rilascio di farmaco (DES) e l’uso più frequente dell’arteria radiale come sito di accesso, contribuendo a favorire negli anni l’aumento delle procedure in regime di day hospital.OBIETTIVO: monitoraggio degli esiti clinici e degli eventi avversi legati alla procedura per consentire di misurare l’appropriatezza del percorso clinico con ricovero breve del paziente candidato, durante la coronarografia, all’angioplastica coronarica con un’osservazione estesa in ricovero ordinario di almeno 24 ore dalla procedura. MATERIALI E METODI: studio descrittivo delle PTCA eseguite in regime di day hospital negli anni 2021/2022. I dati sono stati consultati dal database Suitestensa® dell’emodinamica dell’AST di Ascoli Piceno e sono stati rilevati i seguenti item: aspetti bioclinici legati alla procedura e i fattori di rischio, gli esiti dell’intervento e il sito di accesso utilizzato; le complicanze riscontrate durante l’intervento e in fase di monitoraggio post procedura, e la durata media di degenza.Inoltre sono stati analizzati gli esiti clinici valutati nel periodo del follow-up.RISULTATI: in un campione di 135 pazienti, il 78,52% (n=106) è di genere maschile, il 21,48% (n=29) genere femminile; l’età media risulta essere 69,43. Il 30,37% (n=41) dei casi presenta una diagnosi di malattia coronarica di un singolo vaso, il 28,15% (n=38) malattia di due vasi coronarici, il 25,19% (n=34) malattia di tre vasi, il 6,67% (n=9) presenta una malattia del tronco comune. Il 17,04% (n=23) ha avuto un IMA (Infarto miocardico acuto) pregresso, e il 47,41% (n=64) è già stato sottoposto ad una PTCA, e solamente il 5,19% (n=7) presenta un intervento di bypass aorto-coronarico pregresso. L’80% (n=108) è stato sottoposto a PTCA monovasale, il 20% (n=27) ad un’angioplastica plurivasale, con un’efficacia pari al 97,78% in 132 casi, e l’inefficacia riscontrata nel 2,22% (n=3). I fattori di rischio più significativi riguardano l’ipertensione arteriosa col 69,63% (n=94), la dislipidemia 39,26% (n=53).Il sito di accesso più utilizzato è l’accesso radiale con il 92,59% (n=125), l’accesso femorale in 6 casi pari al 4,44%. La durata media della degenza risulta essere ±2,27 giorni. È stata riscontrata una singola complicanza legata al sito di accesso; complicanze invece legate alla procedura risultano nello 0,74% (n=1) dei casi. Nel periodo del follow-up risultano 103 pazienti, il 76,30% con una prima visita ambulatoriale, 84 assistiti presentano anche una seconda visita, con il 62,22%. Il 94,17% (n=97) e l’88,10% (n=74) dei pazienti visitati non ha avuto eventi cardiovascolari maggiori (MACE- Major adverse cardiovascular event).ANALISI: l’analisi dei dati è stata effettuata mediante l’impiego del foglio di calcolo Microsoft Excel®; la statistica descrittiva e le variabili sono rappresentate mediante frequenza (N.) e il rispettivo valore percentuale (%), organizzati in tabelle e con l’impiego di grafici.DISCUSSIONE E CONCLUSIONI: l’efficacia del trattamento risulta essere molto significativa. Un gran numero di pazienti ha avuto un accesso radiale e un’emostasi efficace, favorita dall’impiego di device performanti.La riduzione degli eventi cardiovascolari maggiori post PTCA con ricovero breve è stata possibile grazie ad una appropriata selezione del paziente, in relazione alla stratificazione del rischio clinico. Le misure di qualità sono definite dagli elementi strutturali, dall’impiego di protocolli diagnostici-terapeutici condivisi in un’ottica multidisciplinare, al fine di garantire un’ottimizzazione dell’attività ospedaliera ed una migliore gestione delle complicanze.Parole chiave: Angioplastica coronarica, outcome clinici, day hospital.
Angioplastica coronarica: analisi degli outcome clinici nel percorso programmato in day hospital nell'AST di Ascoli Piceno.
DANESI, SERENA
2023/2024
Abstract
BACKGROUND: Advances in methodologies applied in PTCA (Percutaneous Transluminal Coronary Angioplasty) have led to a reduction in the risk of perioperative and post-procedural complications, such as the use of drug-eluting stents (DES) and the more frequent use of the radial artery as an access site, contributing over the years to an increase in procedures performed on a day hospital basis.OBJECTIVE: To monitor clinical outcomes and adverse events related to the procedure, allowing the measurement of the appropriateness of the clinical pathway for patients undergoing brief hospitalization, during coronary angiography, for coronary angioplasty with at least 24 hours of extended observation in regular hospitalization after the procedure.MATERIALS AND METHODS: This descriptive study examines PTCA procedures conducted on a day hospital basis in the years 2021 and 2022. Data were retrieved from the Suitestensa® hemodynamic database of the AST of Ascoli Piceno, and the following items were assessed: bioclinical aspects related to the procedure and risk factors, procedural outcomes, and the access site used; complications observed during the intervention and in the post-procedure monitoring phase, as well as the average length of stay. Clinical outcomes evaluated during the follow-up period were also analyzed.RESULTS: In a sample of 135 patients, 78.52% (n=106) were male, and 21.48% (n=29) were female; the average age was 69.43. In 30.37% (n=41) of cases, there was a diagnosis of single-vessel coronary artery disease, 28.15% (n=38) had two-vessel disease, 25.19% (n=34) had three-vessel disease, and 6.67% (n=9) presented with left main coronary artery disease. In total, 17.04% (n=23) had a prior acute myocardial infarction (AMI), and 47.41% (n=64) had previously undergone a PTCA, with only 5.19% (n=7) having a history of aortocoronary bypass surgery. 80% (n=108) underwent single-vessel PTCA, while 20% (n=27) had multi-vessel angioplasty, with an effectiveness rate of 97.78% in 132 cases, and ineffectiveness noted in 2.22% (n=3). The most significant risk factors included hypertension at 69.63% (n=94), dyslipidemia at 39.26% (n=53).The most frequently used access site was the radial access at 92.59% (n=125), with femoral access in 6 cases (4.44%). The average length of stay was ±2.27 days. A single complication related to the access site was reported; complications related to the procedure were observed in 0.74% (n=1) of cases. During the follow-up period, 103 patients were assessed, with 76.30% having a first outpatient visit; 84 patients also had a second visit, with 62.22%. 94.17% (n=97) and 88.10% (n=74) of the assessed patients had no major cardiovascular events (MACE). ANALYSIS: Data analysis was performed using Microsoft Excel®; descriptive statistics and variables were represented by frequency (N.) and corresponding percentage (%), organized in tables and with the use of graphs.DISCUSSION AND CONCLUSIONS: the treatment's effectiveness is highly significant. A large number of patients underwent radial access and effective hemostasis, supported by the use of high-performance devices. The reduction in major cardiovascular events post PTCA with brief hospitalization was made possible through appropriate patient selection according to clinical risk stratification. Quality measures are defined by structural elements, the use of shared diagnostic-therapeutic protocols within a multidisciplinary framework, aimed at optimizing hospital activity and improving the management of complications.Keywords: Coronary angioplasty, clinical outcomes, day hospital.File | Dimensione | Formato | |
---|---|---|---|
Danesi Serena Tesi.pdf
accesso aperto
Descrizione: documento di tesi Danesi Serena
Dimensione
601.94 kB
Formato
Adobe PDF
|
601.94 kB | Adobe PDF | Visualizza/Apri |
I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.12075/19989