A retrospective review of fmc practice guidelines for post percutaneous coronary intervention care in metropolitan vs non-metropolitan patients.

Abstract

Stent thrombosis is a rare early complication of percutaneous coronary intervention (PCI) best managed by repeat angiography. Subsequently, our department has enforced a policy of retaining patients near a major centre for 5 days post PCI, including our rural patients. The purpose of this audit was to clarify the risk for country patients returning home within 5 days. Between January 2005 and June 2015 electronic databases identified all patients residing in SA who underwent PCI at Flinders Medical Centre (FMC), and separated them into Metro and Country designations. Demographics and comorbidities were compared, and outcomes of death, major adverse cardiac events (MACE) and MACE/Revascularisation (MACE/R) were noted within five and 30 days. In total, 3,911 patients were included (mean age: 63 years, female: 25.2%). Country patients (n= 1,412, 36.10%) were significantly less likely to have previous comorbidities, including previousACS(30.7% v 23.6%, p<0.01) and were less likely to haveMACE,both within 5 (1.5% v 0.8%, p=0.045) and 30 days (3.6% v 2.0%, p=0.004), and MACE/R within 30 days (7.0% v 4.5%, p=0.001). There was no significant difference in the rates of death within 5 or 30 days, or MACE/R within five days. Mortality by five days was low for both country and metropolitan patients (0.8% and 1.3% respectively) and did not differ significantly between groups (p=0.149). Country patients can be discharged home prior to 5 days if accepting of a <1% risk of early death within this time frame.