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Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Study Questions:
What are the outcomes of same-day discharge (SDD) following percutaneous coronary intervention (PCI) versus overnight hospitalization (ON)?
Methods:
The Cochrane search strategy was used to search the PubMed database, EMBASE, and the Cochrane Library for relevant literature. Thirteen studies (five randomized and eight observational) of SDD after uncomplicated PCI versus ON met inclusion criteria. Data were pooled using a random-effects model, and reported as odds ratios (ORs) with their 95% confidence intervals (CIs). The primary outcomes were incidence of total complications, major adverse cardiovascular events (MACE), and rehospitalization within 30 days after PCI.
Results:
A total of 13 studies involving 111,830 patients were pooled. There was significant variation in the definition of outcomes across studies. For total complications, the strategy of SDD compared with ON after PCI had an estimated OR of 1.20 (95% CI, 0.82-1.74) in randomized and 0.67 (95% CI, 0.27-1.66) in observational studies. Similar results were found for MACE (randomized: OR, 0.99; 95% CI, 0.45-2.18; observational: OR, 0.59; 95% CI, 0.06-5.57) and rehospitalizations (randomized: OR, 1.10; 95% CI, 0.70-1.74; observational: OR, 0.62; 95% CI, 0.10-3.98) at 30 days post-PCI.
Conclusions:
The authors concluded that until additional prospective data are available, SDD after uncomplicated PCI seems to be a reasonable approach in selected patients.
Perspective:
This study suggests that many carefully selected and risk-stratified groups of patients undergoing elective or ad hoc PCI for low–intermediate risk ACS can be managed successfully with a SDD strategy. However, due to the low event rate, the significant variation in the definition of outcomes across studies, and wide CIs around the point estimates, a definitive resolution of a statistically significant hazard or benefit to the SDD approach cannot be determined based on the totality of presently available data. Until an adequately powered multicenter randomized trial is completed, SDD after uncomplicated PCI may be a reasonable approach only in carefully selected patients.
Keywords: Incidence, Myocardial Infarction, Cardiology, Cardiac Surgical Procedures, Angioplasty, Patient Discharge, Hospitalization, Percutaneous Coronary Intervention
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