1. The RAdial SAme Day DischArge after PCI The RASADDA-PCI trial
William Rollefson1, Mehmet Cilingiroglu1, David Mego1, Abdul Hakeem2, Ian Cawich1, Vasili Lendel1, Andre Paixao1, Konstantinos Marmagkiolis3, Daniel Sherbet1, Patrick Flaherty1, Gerardo Rodriguez-Araujo1 1Arkansas Heart Hospital, Little Rock, AR;
2University of Arkansas for Medical Sciences, Little Rock, AR
3Florida Hospital Pepin Hospital Institute, Tampa, FL

2. Disclosures
Funding
This study was performed with the support of Terumo, Inc.
Consultant:
Terumo Medical
Medtronic
Endologix.

3. Background
Transradial (TR) PCI rates have been progressively increasing over the last decade (up to 15x increase).
Same-day discharge after elective PCI is associated with similar safety compared to overnight observation
This study sought to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI.

4. Mention that the prior 4/5 RCTs were exclusively transfemoral, mostly performed > 10 years ago and did not assess cost in the US healthcare market

5. ACC NCDR registry N = 107 018 Same-day discharge 1.25% (1.19%-1.32%)
Significant variation across facilities.

6. Arkansas Heart Hospital
Diagnostic Cath
3000 PCI
80-90% Radial Access
SDD increased from <5% to 75% since 2013

7. Study Design Prospective- Retrospective Comparative Two- Arm
Consecutive transradial PCIs
Same Day vs One Night Stay
852 Elective PCI patients
429
423

8. Inclusion Criteria Age ≥18 years and ≤80 years .
Single or multi-vessel coronary artery disease.
Indication of TR-PCI
Life expectancy greater than 30 days.

9. Exclusion Criteria Patients without health insurance.
Complicated type 2 diabetes mellitus.
History of cancer within the past 5 years.
Presence of any other clinically-significant medical condition, psychiatric condition, or laboratory abnormality, that in the judgment of the Investigator or Sponsor for which participation in the study would pose a safety risk to the subject
Participation in another study with an investigational drug or device within 1 month prior to treatment
Allergy to sodium citrate or any “-caine” type of local anesthetic.

10. Baseline Demographic And Characteristics
Variable
SD*
ON*
p-value N
245
Age
66.40 ± 9.10
66.27 ± 10.81
0.8886
Gender (Masc)
61.2% (150)
1.0000
Hispanic/Latino
0.8% (2)
Not hispanic/latino
99.2% (243)
Asian
0% (0)
0.4% (1)
0.3178
Black/ African American
4.9% (12)
6.1% (15)
0.5535
White
94.3% (231)
92.7% (227)
0.4656
Other
BMI
/-30.30
/-6.594
0.9341
Type 2 Diabetes Mellitus
40.0% (98)
40.8% (100)
0.8543
Tobacco Use
52.7% (129)
51.8% (127)
0.8568
Hypertension
76.3% (187)
74.7% (183)
0.6751
Prior PCI
54.2% (133)
53.1% (130)
0.7863
Recent Hospitalization for CV Cause
2.0% (5)
0.0246
Prior Myocardial Infarction
Prior Stroke .
Medications:
GP IIb/IIIa inhibitor
Aspirin
70.2% (172)
70.0% (171)
0.7689
Insulin/Other antidiabetic
32.2% (79)
34.3% (84)
0.6325
Statin
64.5% (158)
0.4555
ACE inhibitor
40.4% (99)
38.4% (94)
0.6447
Beta Blocker
63.3% (155)
62.4% (153)
0.8520
ARB
16.7% (41)
18.0% (44)
0.7211
Nitrate
30.2% (74)
27.8% (68)
0.5511
Warfarin
Low molecular weight heparin
Unfractionated heparin
* Values Represent Means ± SD or Percentage (n value) .
This table includes only the propensity matched patients. The main point to be made here is the groups were well matched and no significant differences were detected in the measured variables after matching.

11. Max % stenosis prior PCI Number of balloons used
Procedural Outcomes
Variable
SD (n ± SD)
ON (n ± SD)
p-value n
245
Number of stenosis
1.26 ± 0.465
1.21 ± 0.481
0.2431
Max % stenosis prior PCI
83.57 ± 8.99
84.44 ± 9.24
0.2943
Stenting
97.6% (239)
96.3% (236)
0.4325
Number of stents used
1.245 ± 0.584
1.245 ± 0.632
1.0000
DES
87.3% (214)
82.4% (202)
0.1306
BMS
11.8% (29)
14.7% (36)
0.3522
PTCA
56.7% (139)
61.2% (150)
0.3174
Number of balloons used
0.840 ± 0.957
0.943 ± 0.986
0.2432
Total Contrast Volume
± 62.63
± 57.70
0.8220

12. 30- Day Outcomes
*P value non significant for all comparisons

13. 30 Day- Cumulative Cost(USD) of TR-PCI Procedure
Variable
SD (n ± SD)
ON (n ± SD)
p-value n
245
Total Cost for Procedure/Hospitalization
3346 ± 1280
4682 ± 28450
<0.0001
Total Cost at 30 Day Follow Up
4493 ± 1887
7112 ± 4226
Total Cost for Concomitant Medications
25 ± 71
32 ± 98
0.3688
$1336- $2619

14. Costs
P<0.0001

15. Limitations Non randomized study
Propensity matching to control for baseline differences in the two groups
Experienced center with most operators routinely using TR access
Generalizability to other settings warrants further study

16. Conclusions
In patients undergoing TR PCI, same-day discharge is as safe and effective as overnight observation.
SD discharge is associated with robust cost reduction compared to overnight observation.
Significant implications for health care economics.

18. Retrospective vs Prospective
Variable ON SD n
245
Retrospective (%)
78.4
57.6
Prospective (%)
21.6
42.4