Same-Day Discharge After Percutaneous Coronary Intervention: A Meta-Analysis
What is the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI)?
The authors performed a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. The study had two prespecified composite outcomes: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications.
The authors pooled data from 12,803 patients enrolled in 37 studies. Of the total, seven were randomized controlled trials (RCT) (n = 2,738), and 30 were observational studies (n = 10,065). The majority of patients underwent PCI for stable angina. The vascular access site was predominantly transradial in the randomized cohort (60.8%), and transfemoral in the observational cohort (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.43-1.87; p = 0.78), or for major bleeding/vascular complications (OR, 1.69; 95% CI, 0.84-3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI, 0.58-1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI, 0.35-1.32%). There were 15 deaths reported in the same-day discharge group, of which 11 occurred after 24 hours while the timing was unclear in the remaining four deaths.
The authors concluded that same-day discharge is safe in carefully selected patients undergoing elective PCI.
Same-day discharge after PCI is uncommon in the United States despite a growing body of data supporting its safety. This study collates the published evidence base, and demonstrates that such a practice is safe and associated with similar outcomes as overnight stay. The cost-effectiveness of same-day discharge has not been evaluated, but it is likely that such a practice will save money for hospitals. Previously published guidelines on same-day discharge exclude a large proportion of patients undergoing PCI, and further research is needed to define the criteria that might help optimize patient selection for same-day discharge.
Keywords: Myocardial Infarction, Angina, Stable, Myocardial Revascularization, United States, Percutaneous Coronary Intervention
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