R. Ocaranza

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Arrhythmic Manifestation of Prinzmetal' Sangina Induced by Therapeutic Hypothermia

International Journal of Clinical Cardiology, 2015

We report the case of a 37-year-old Caucasian man, with prior history of smoking and DM. He had c... more

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[Myocardial injury caused by reperfusion]

Archivos de cardiología de México

Arterial coronary occlusion produces ischaemic changes, and alter the aerobic metabolism, creatin... more Arterial coronary occlusion produces ischaemic changes, and alter the aerobic metabolism, creatinephosphate depletion and accumulation of anoxic metabolites in the ischaemic tissue, with an alteration in the calcium regulation. With the recovery of the blood flow, the myocardial ischaemic injury and infarct zone are diminished, leading to an improvement of survival. The adverse effect induced by the reperfusion of ischaemic cells with the production of free radicals and dearrangements in the glucose metabolism, fatty acids and intracellular calcium flow as well, has been proven. There are 4 kinds of reperfusion damage: stunned myocardium, reperfusion arrhythmia, no-reflow phenomena, and cellular death, all of them with a particular physiopathology. Nowadays, there are too many paraclinics in order to reach a diagnosis, and perhaps the only available treatment is still under research. This field has great expectancy in the future. In this article, some of the contemporary concepts ar...

Clinical findings as predictors of positivity of head-up tilt table test in neurocardiogenic syncope

Archives of Medical Research, 2003

Neurocardiogenic (vasovagal) syncope occurs frequently and can be diagnosed with the head-up tilt... more Neurocardiogenic (vasovagal) syncope occurs frequently and can be diagnosed with the head-up tilt table (HUTT) test. Our objective in this study was to identify clinical predictors of the positivity of HUTT test in neurocardiogenic syncope. We conducted a prospective study of 117 cases (81 women and 36 men, 13-85 years of age) referred to our Institution for HUTT testing. The ability of 10 symptoms and signs of clinical history to predict HUTT positivity were evaluated using logistic regression analysis. We observed a low rate of test-negative cases (24%) and 89 positives. Nearly all positives (87/89) were neurocardiogenic, principally of vasodepressor and mixed types (43 and 34 cases, respectively) and a few were cardioinhibitory (10, mostly young males). Regression analysis established that dizziness, nausea, and diaphoresis in past history were associated with HUTT positivity nearly 25 times more frequently than when absent. Our three conclusions are that syncope in absence of heart disease accompanied by dizziness, nausea, and diaphoresis may be treated as neurocardiogenic in settings where no HUTT is available. In addition, our low rate of negative tests may have been the result of our reexamining referrals prior to deciding test performance, and high frequency of young males in cardioinhibitory syncope needs further research.

Myocardial Reperfusion Injury

Journal of Thrombosis and Thrombolysis, 1997

Hispanic Parent/Caregiver Health Literacy: Examining Effect on Pediatric Emergency Department Utilization

This study aimed to explore Hispanic parent/caregiver health literacy and emergency department (E... more This study aimed to explore Hispanic parent/caregiver health literacy and emergency department (ED) utilization for children ages birth to 10 years of age from a single outpatient pediatric primary care office in Wilmington, Delaware. English language proficiency (ELP) was measured to determine whether ELP was a moderating variable for ED utilization in children of Hispanic parents/caregivers. The following research question was explored in this study: "Are there significant differences between levels of health literacy and emergency department utilization rates when controlling for level of English language proficiency in Hispanic parents/caregivers?" The research question was guided by the following hypothesis: "Hispanic parents/caregivers with higher levels of health literacy utilize emergency department services at lower rates when controlling for levels of English language proficiency." iv Dedication Gracias a Dios y la Virgen de Guadalupe. Para mi querido esposo, Fernando, y la luz de mis ojos, Jimena. Los amo. Mis padres, Andrea y Juan Martin, por su apoyo y amor. v Acknowledgements I must acknowledge the dedication, patience, and commitment of my committee in this process. Thank you Señor Mudcat, I am forever grateful for your time. You are a tough cookie and I respect you for that. It was a humbling experience to doubt my own sanity and intelligence. Thank you Dr. Proctor for taking on a 3 credit independent study to teach me ANOVA! Amongst all the madness, you guided me and responded to hundreds of my emails. Dr. Redcay, thank you for your time, dedication, and taking my late calls. You listened to me and that meant a lot.

Absolute coronary flow and microvascular resistances in severe aortic stenosis: invasively quantification

European Heart Journal

Background Chest pain in aortic stenosis (AS) has been attributed to the loss of coronary flow re... more Background Chest pain in aortic stenosis (AS) has been attributed to the loss of coronary flow reserve however; this has not been directly quantified to date. Purpose To determine whether there is a decrease in coronary flow as a cause of chest pain or dyspnea in patients with severe AS Methods Patients with AS and normal left ventricular ejection fraction (LVEF) underwent coronariography previous to valve replacement. In those patients without obstructive coronary disease, an invasive physiological evaluation was performed to measure absolute coronary flow (Q) and microvascular resistances (R). Left anterior descending artery (LAD) was explored in all cases and, in a subgroup of patients, we also studied the circumflex (CX). Results 51 patients were included. 86% presenting with dyspnea, 26% also reported chest pain, and 11.8% syncope. No patient was admitted due to heart failure. Mean pressure gradient for AS was 52.44±15.41 mmHg with a mean aortic valve area of 0.76±0.17 cm2. Mea...

Proceso de remodelado arterial negativo tras cateterización transradial

Angiología, 2018

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique

Revista Portuguesa de Cardiologia, 2016

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique 3 Protection of hu... more

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“Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients”

International Journal of Cardiology, 2016

To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascula... more To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. Background: Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. Methods: A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed. Results: Mean and maximal postdilatation pressure were 17 ± 3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09 ± 0.34 mm, 2.88 ± 0.31 mm and 3.31 ± 0.40 mm. Mean eccentricity index was 0.13 ± 0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30 days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR). Conclusions: NC balloon HPP of BVS at more than 17 atm (up to 20 atm) is safe during PCI and allows to achieve better angiographic and clinical results.

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 18, 2015

Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovas... more Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. ...

Mehran contrast nephropathy risk score: Is it still useful 10 years later?

Journal of Cardiology, 2016

Background: Nowadays, contrast-induced nephropathy (CIN) is the third cause of acquired acute ren... more Background: Nowadays, contrast-induced nephropathy (CIN) is the third cause of acquired acute renal impairment in hospital. CIN is related to increased in-hospital morbidity, mortality, costs of medical care, and long admissions. Because of this, we hypothesized it would be useful to determine the risk of CIN with scores such as the Mehran score. The aim of this study was to validate the Mehran score in a contemporary cohort of Spanish patients with acute coronary syndrome (ACS). Methods: We assessed the calibration and discriminatory capacity of Mehran score to predict CIN in a cohort of 1520 patients with a definitive diagnosis of ACS and who underwent coronary angiography between March 2008 and June 2012. We excluded patients on chronic dialysis and those without data of contrast volume. The calibration of the model was assessed with the Hosmer-Lemeshow goodness-of-fit test and discriminatory capacity was assessed by C-statistic, which is equivalent to the area under the receiver-operating characteristic curve. Results: From the total group, 118 patients (7.8%) developed CIN. They were older, with higher rates of diabetes (DM) and hypertension and worse renal function and anemia (p < 0.001). The odds ratios for different score components in Mehran's population versus our study were similar except for DM, hypotension, and intra-aortic balloon pump (1.6%, 2.68%, 2.55% vs 0.9%, 1.89%, and 2.86%, respectively). Calibration and discriminatory capacity of Mehran score were excellent with a Hosmer-Lemeshow p = 0.7, C-statistic value >0.8. Conclusions: Mehran risk score has been validated in our study as a good score for predicting CIN in patients with ACS who underwent coronary angiography. According to this, we support its use in patients hospitalized for ACS in order to identify the ones at risk, and to optimize CIN prophylactic therapy prior to and after catheterization.

A new simple algorithm to stratify the risk of contrast-induced nephropathy in patients with acute coronary syndrome

European Heart Journal, 2013

Objectives and background: Previous studies on contrast-induced nephropathy (CIN) have identified... more Objectives and background: Previous studies on contrast-induced nephropathy (CIN) have identified contrast volume (CV) as a risk factor. The aim of our research was to define the safe dose of contrast media based on absolute CV, maximum allowable contrast dose (MACD) and estimated glomerular filtrate rate (eGFR). Methods and results: A total of 940 consecutive patients with acute coronary syndrome (ACS) were enrolled. Fifty-four patients developed CIN. MACD was defined as 5*body weight/serum creatinine. When using a CV higher than MACD, CIN-risk was increased 19-fold (OR 9.810—39.307, p<0.001). For the CV/eGFR ratio, we found that for every increase of one-tenth, CIN-risk increased by 4.9% (OR 1.037–1.061, p<0.001). The discriminative ability of CV (C statistic=0.626±0.038) was significantly lower than for the CV/MACD (C statistic=0.782±0.036, p=0.003) and CV/eGFR (C statistics: 0.796±0.033 for MDRD-4, 0.796±0.034 for Cockcroft-Gault, and 0.803±0.033 for CKD-EPI; p<0.001). There were no differences in the discriminative ability to predict CIN between the three eGFR equations. The combination of CV/MACD and CV/eGFR in a single protocol increases the positive predictive value of the Mehran risk score (40.7% vs 8.8%) with the same sensitivity (90.7% vs 83.3%). High doses of relative CV (CV/MACD and CV/eGFR) were also significantly associated with higher in-hospital mortality, reinfarction, and heart failure. ![Figure][1] Prediction of CIN risk Conclusions: A sequential protocol based on CV/MACD and CV/eGFR appropriately identified those ACS patients who developed CIN, with predictive values similar to a Mehran score, reducing the false positive rate. It is also useful to predict risk of in-hospital cardiac events regardless of GRACE score. [1]: pending:yes

Is final kissing balloon a safe technique for the final treatment of bifurcation lesions?

European Heart Journal, 2013

The aim of the study is to explore the influence of end-procedural ischemia (detected with intrac... more The aim of the study is to explore the influence of end-procedural ischemia (detected with intracoronary electrocardiography (icECG)) and occlusion of secondary side branches arising in the reigion of coronary bifurcation stenosis (but not assessed as significant side branches) on revascularization rates (TLR) and cumulative MACE (death, myocardial infarction, TLR, rehospitalization) rates at 9-12 months after PCI. Methods: After placement of intracoronary guidewires in main branch (MB) and side branch (SB) an uninsulated proximal ends of wires were connected to unipolar V leads. Intracoronary unipolar ECGs (icECG) were recorded before, during and after stent placement and at the end of procedure. The maximal ST-segment elevation during intervention and 5 min after the procedure was recorded in SB and MB. At the end, the coronary wire was placed in every distal vessels with reference caliber >1.0mm, as well as in MB just below the stent, "mapping" the zones for ischemia presence and distribution. Provisional T-stenting was a default strategy. The patient population consists from 91 patients with stable/unstable angina: 72% were males, mean age 66±8, diabetics 34%; 43% had previous myocardial infarction, 41% previous PCI and 58% had multivessel disease. The main treated vessel was LAD (72%). True bifurcation lesions (Medina xx1) were 51%. The maximal ST-segment elevation on icECG ( ) was 12±9 mm in MB and 8±7 mm in SB (p=0.044). At the end of the procedure the distribution of icECG changes was as follows: 23% SB only, 21% MB only, 27% in both, 12% ST depression in SB or MB, 1.5% with SB ST-depression and MB STelevation, 1.5% with ST-depression in both branches. Changes on icECG have 78% sensitivity, 97% specificity for detection of post-procedural troponin elevation. At 10±4 months follow-up there were 6 (6.5%) TLR and 14 (15.3%) MACEs. The rate of small branch occlusion was 33% in group with TLR vs. 4.8% in group without (p<0.001). The only independent predictor of MACE on multivariate analysis is i.c. ECG ST changes at the end of PCI or occlusion of secondary branch: OR 2.606, CI 1.127-5.878, p=0.016. The end-PCI intracoronary ECG ST-segment changes combined with occurrence of secondary branch occlusion could predict future adverse events after single stenting of coronary bifurcation lesions.

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Real world comparison of the MGuard Stent versus the bare metal stent for ST Elevation myocardial infarction (The REWARD‐MI study)

Catheterization and Cardiovascular Interventions, 2014

Aim: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been ... more Aim: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been shown to improve microcirculation in ST‐elevation myocardial infarction (STEMI). However, there are no real world data comparing it with the bare metal stent (BMS). The aim of this study is to determine the efficacy and safety of the MGS in STEMI in the real world compared to the BMS.Methods and Results: In total, 262 patients were included from a single centre, of which 35.9% had an MGS implanted. Two groups of 79 patients were established after propensity score matching, and they were similar in terms of baseline and periprocedural variables. The mean follow‐up was 321 ± 12.94 days. There was no difference in mortality (7.6% in both groups), major adverse cardiac events (20.3% vs. 12.7%, P = 0.198), non‐cardiac mortality, or non‐fatal myocardial infarction (6.3% in both groups). Target lesion revascularization (TLR) was significantly higher in the MGS group (11.4% (9) vs. 1.3% (1) P &l...

Comparative performance of glomerular filtrate rate estimated by creatinine, cystatin C or both to predict contrast induced nephropathy in acute coronary syndrome

European Heart Journal, 2013

Purpose: Coronary angiogram (CA) with percutaneous coronary intervention (PCI) on admission may i... more Purpose: Coronary angiogram (CA) with percutaneous coronary intervention (PCI) on admission may improve survival to hospital discharge in patients resuscitated from an out-of-hospital cardiac arrest (OHCA), but data on the long-term survival are rare. The purpose of our study was to assess long-term survival in OHCA patients managed with CA on admission and PCI if indicated and to compare survival between patients with and without acute myocardial infarction (AMI). Methods: Retrospective single-centre study including patients ≥18 years old resuscitated from an OHCA without obvious non-cardiac cause undergoing CA on admission with PCI if indicated. AMI was diagnosed angiographically as presence of lesions suggestive of ruptured plaques with critical stenosis and presence of thrombus easily crossed by an angioplasty wire. Survival was recorded at hospital discharge and at 5-years follow-up and probability of survival was estimated by Kaplan-Meier survival curves. Data are expressed as numbers (percentages) and median (interquartile range-IQR). Results: 300 comatose patients aged 56 (48-67) were included between 2002 and 2011. 130 patients (43%) had ventricular fibrillation, 116 (39%) asystole, 6 (2%) ventricular tachycardia, 18 (6%) pulseless electrical activity and 30 (10%) had unknown initial rhythm. All patients had CA on hospital admission and 93 (31%) had angiographically defined AMI. PCI was attempted in 85 (91%) of the patients with AMI, successful in 79 (93%) of the attempts. Therapeutic hypothermia was performed in 256 (84%) of the patients. Survival at hospital discharge was 32.3% (97 survivors). After hospital discharge, 5-year overall probability of survival was 81.7±5.4%. Probability of survival from admission to 5-year follow-up was 26.2% ± 2.8%. Patients with AMI had better survival at hospital discharge, 40.8% (38 survivors) than non-AMI patients, 28.5% (59 survivors), p=0.047. There was a tendency for better post-discharge probability of survival at 5-years follow-up in AMI patients, 92.2% ± 5.4% versus 73.4±8.6% in non-AMI patients, hazard ratio (HR) = 2.7, confidence interval (CI) = (0.8-8.9), p=0.1. Probability of survival from admission to 5-years follow-up was better for AMI patients, 37.4% ± 5.2% than for non-AMI patients, 20.7% ± 3.0%, HR = 1.5, CI = (1.12-2.0), p=0.0067. We observed a very favourable post-discharge prognosis in OHCA patients undergoing on-admission CA with PCI if indicated. In this study, patients suffering OHCA due to AMI had better survival to hospital discharge and at 5 years follow-up than patients suffering OHCA due to other causes.

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Identification of a circulating microvesicle protein network involved in ST-elevation myocardial infarction

Thrombosis and haemostasis, 2014

Membrane microvesicles (MVs) are released from activated cells, most notably platelets, into the ... more Membrane microvesicles (MVs) are released from activated cells, most notably platelets, into the circulation. They represent an important mode of intercellular communication, and their number is increased in patients with acute coronary syndromes. We present here a differential proteomic analysis of plasma MVs from ST-elevation myocardial infarction (STEMI) patients and stable coronary artery disease (SCAD) controls. The objective was the identification of MVs biomarkers/drug targets that could be relevant for the pathogenesis of the acute event. Proteome analysis was based on 2D-DIGE, and mass spectrometry. Validations were by western blotting in an independent cohort of patients and healthy individuals. A systems biology approach was used to predict protein-protein interactions and their relation with disease. Following gel image analysis, we detected 117 protein features that varied between STEMI and SCAD groups (fold change cut-off ≥2; p<0.01). From those, 102 were successful...

High-sensitivity C-reactive protein predicts adverse outcomes after non-ST-segment elevation acute coronary syndrome regardless of GRACE risk score, but not after ST-segment elevation myocardial infarction

Revista Portuguesa de Cardiologia (English Edition), 2013

The study aimed to assess the association of high-sensitivity C-reactive protein (hsCRP) and N-te... more The study aimed to assess the association of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to major adverse cardiovascular events (MACE) in Takayasu arteritis (TA) patients with coronary artery disease (CAD). Data on 60 TA patients with CAD and 60 age-and severity-matched patients with CAD hospitalized in Fuwai Hospital from 2005 to August 2014 were assessed. The clinical features, laboratory data, coronary angiographic findings, treatment, and follow-up outcomes were summarized retrospectively. MACE were defined as death from cardiac causes, myocardial infarction, nonfatal target vessel revascularization, or rehospitalization due to unstable or progressive angina. CAD patients had more atherogenic lipid and lipoprotein profiles such as lower levels of high-density lipoprotein cholesterol (HDL-C) (1.0±0.2 vs. 1.3±0.3 mmol/L, p= 0.01) and higher levels of low-density lipoprotein cholesterol (LDL-C) (2.5±0.9 vs. 2.2±1.1 mmol/L, p=0.04) in contrast with TA-CAD patients. During a mean follow-up period of 3.2 years, 31 patients with Takayasu coronary arteritis reached the endpoint. Multivariate Cox proportional hazards model demonstrated that log(hsCRP) (HR =5.3, 95 % CI=1.1-27.8, p=0.04) was a significant and independent predictor of MACE in patients with Takayasu coronary arteritis. Elevated baseline levels of hsCRP predict cardiovascular events, independent of other prognostic markers in TA-related CAD patients.

Contrast Induced Nephropathy and Bleeding: A Bidirectional Link with Prognostic Value in Acs

Journal of the American College of Cardiology, 2013

The 2 most common non-thrombotic in-hospital complications in patients with Acute Coronary Syndor... more The 2 most common non-thrombotic in-hospital complications in patients with Acute Coronary Syndorme (ACS) were contrastinduced nephropathy (CIN) and bleeding. The aim was to analyse the relationship between CIN and bleeding in a contemporaneous cohort of ACS patients, together with the predictive value of both for adverse in-hospital mortality. methods: A total of 940 consecutive patients with ACS were enrolled. CIN was defined based on an increase in serum creatinine ≥ 0.5 mg/dL within 72 hours of exposure. In-hospital bleeding presence and severity was recorded using TIMI scheme. Two binomial logistic regression models were used to evaluate the prognostic value of pre-catheterization bleeding to predict CIN and the independent value of the CIN to predict postcatheterization in-hospital bleeding. results: 54 patients presented CIN (5.7%) and 60 bleeding (6.4%; Major TIMI bleeding in 13 patients). Patients who had had bleeding previous to catheterization, or in relation with it, developed more CIN (30.0% vs 5.2%, p[[Unable to Display Character: ˂]]0.001). After multivariate adjustment, pre-catheterization bleeding was an independent predictor of the development of CIN ), p=0.003], together with Mehran CIN score and troponin peak. The presence of CIN was also associated with a higher percentage of post-catheterization bleeding (18.5% vs 3.4%, p[[Unable to Display Character: ˂]]0.001). Adjusting by CRUSADE score, the development of CIN was found to be an independent predictor of post-catheterization bleeding .08), p=0.010]. After adjusting for the GRACE score, both variables (CIN and bleeding) resulted independent predictors of in-hospital death, increasing the power when both were combined p=0.001]. conclusion: Pre-catheterization bleeding was an independent predictor for the occurrence of CIN, and in a bilateral way, the development of CIN resulted an independent predictor for post-catheterization bleeding. In addition to this, CIN and bleeding increase the in-hospital death risk with independence of GRACE score, and the combination of both enhance this risk.

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SP32 Geographical determinants associated to the prevalence of metabolic syndrome and atherosclerosis. A pilot study in patients sent for diagnostic catheterization in northern Spain (Galicia)

European Journal of Cardiovascular Nursing, 2009

it is possible to set up a follow up program involving in hospital nurses and primary care nurses... more

96 Poster Safety and efficiency of nursing care in ambulatory PCI

European Journal of Cardiovascular Nursing, 2010

The number of percutaneous coronary interventions (PCI) has increased gradually in the cath-labs ... more The number of percutaneous coronary interventions (PCI) has increased gradually in the cath-labs around the world. The development of minimally invasive technologies, the transradial approach and all the new antithrombotic drugs have made possible the decrease of the hospitable stay after PCI. This increase in the safety of the procedure joined the increase of the number of coronary procedure has gone to considering the ambulatory PCI in units of high volume. Objective: To analyze the efficiency of the nursing care in the ambulatory PCI. Methods: During the year 2008, were analysed al data of 365 patients sent to our cath-lab for ambulatory PCI. Nursing care procedures were established in a specific protocol for these ambulatory cases. Inclusion criteria: ambulatory programmed patients transradial access or femoral with use of closure device, coronary lesions type A y/o B, previous double antiaggregant drugs >3 days, informed signed, success of the procedure, home <1 hour of the cath-lab, family support, telephone number and own vehicle. Exclusion criteria: arterial sheath >6F, complex coronary lesions, hemodynamical instability, increase of cardiac markers 6 hours after the ICP and impossibility of follow-up. Nursing care post-ICP were established in: valuation of the ECG, alertness of the signs and symptoms of the precocious complications and its resolution, to emphasize the antiaggregant treatment, taken care of the vascular access, valuation of autonomy, analysis of enzymes later 6 hours. At the home discharge sanitary education was realized to the patient and the family, delivery of the guide of recommendations, valuation of the adhesion to the antiaggregant drugs and date of ambulatory revision in 24-48 done by the nursing staff. Results: Of 365 patients taken to elective PCI, 90 patients were excluded from the study deposited for fulfilling someone of the criteria of exclusion. 285 (74%) patients returned to home with early discharge. In 259 (91%) the transradial access was done and 26 (9%) were femoral access. In the femoral access branch, in 4% a closure vascular device were implanted in 9% mechanical compression was used. There was 1 vagal reaction in the moment of the discharge that did not need hospitalization. There was neither any cardiac major event nor any hospital re-admission. Conclusions: The quality of nursing care for the ambulatory PCI makes possible the early discharge of the patient of a sure and effective way.

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