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Background: Considerable variability remains as regards the appropriate and safe length of stay after elective PCI. We performed a survey of interventional cardiologists to identify current views on appropriate and safe length of stay after PCI., Methods: We created an online survey using the commercially available SurveyMonkey application. This was sent to interventional cardiologists in the US, Canada and the UK with the assistance of the national interventional cardiology societies (SCAI, CAIC/CCS, BCIS/BCS) as well as being made available on the theheart.org website., Results: 505 interventional cardiologists responded, of which 237 were practicing in the US. Of those from the US, 52% were not aware of any guidelines for length of stay and 48% reported that their unit did not have a standard practice for length of stay. Same-day discharge after PCI was practiced as routine by 14% of cardiologists in the US versus 32% of cardiologists from Canada (P = 0.003) and 57% (P < 0.0001) from the UK. Amongst respondents, there was significant variation between respondents and divergence from published SCAI guidelines regarding appropriate length of stay for patient specific and procedural related clinical factors., Conclusions: There is considerable variation in practice patterns regarding length of stay after PCI. Whilst most cardiologists practice overnight observation, a significant minority utilize same-day discharge. There is also lack of familiarity with published guidelines. This variation and knowledge gap confirms an urgent need for updated guidelines and a concerted effort to educate cardiologists on appropriate post-PCI length of stay. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Fifty-two patients were randomized into two groups of 26 to the use of either 5 or 7/8F catheters for their first left heart cardiac catheterization. Clinical characteristics for the two groups were similar. 5F catheters were significantly inferior to 7/8F catheters in terms of torque control (P less than .001), ease of engaging coronary ostia (P less than .001), and quality of angiograms (P less than .05). Nine patients in the 5F group required a change to 7/8F catheters for completion of the procedure. There was no difference in procedure time or fluoroscopy time between the groups. Time to haemostasis was significantly shorter in the 5F group (P less than .01), but there was no difference between groups with respect to haematoma formation or rebleed after haemostasis. We conclude the slight advantage of 5F catheters in terms of haemostasis is outweighed by many disadvantages. Their routine use in cardiac catheterization, at least at this time, cannot be recommended.

Arterilization of the coronary venous system has been suggested as a means of myocardial perfusion. We recently studied a patient with a saphenous vein aorto=coronary venous bypass graft created inadvertently during surgery intended to bypass the anterior descending artery. We selectively injected onctrast into this graft during balloon occlusion of the coronary sinus both before and after sublingual nitroglycerin. No arterial visualization was demonstrated from the vein and no evidence to suggest perfusion of the myocardium was found.