Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes

• Published in: The American heart journal 2022-04, Vol.246, p.125-135
• Main Authors: Hariri, Essa, Kassas, Ibrahim, Hammoud, Mazen Al, Hansra, Barinder, Akhter, Mohammed W., Fisher, Daniel Z., Smith, Craig S., Barringhaus, Kurt G.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - surgery; Acute coronary syndromes; Biomarkers; Bleeding; Calcium-binding protein; Cardiovascular disease; Disorders; Female; Humans; Length of Stay; Male; Medical imaging; Medical records; Middle Aged; Mortality; Patient Discharge; Patients; Percutaneous Coronary Intervention - methods; Radial Artery; Risk groups; Social security; Treatment Outcome; Troponin
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2021.12.015

Timing of discharge after percutaneous coronary intervention (PCI) is a crucial aspect of procedural safety and patient turnover. We examined predictors and outcomes of same-day discharge (SDD) after non-elective PCI for non-ST elevation acute coronary syndromes (NSTE-ACS) in comparison with next-day discharge (NDD). Baseline demographic, clinical, and procedural data were collected as were in-hospital outcomes and post-PCI length of stay (LOS) for all patients undergoing non-elective PCI for NSTE-ACS between 2011 and 2014 at a central tertiary care center. Thirty day and 1-year mortality and bleeding as well as 30-day readmission rates were determined from social security record and medical chart review. Logistic regression was performed to identify predictors of SDD, and propensity-matched analysis was done to examine the differences in outcomes between NDD and SDD. Out of 2,529 patients who underwent non-elective PCI for NSTE-ACS from 2011 to 2014, 1,385 met the inclusion criteria (mean age = 63 years; 26% women) and were discharged either the same day of (N = 300) or the day after (N = 1,085) PCI. Thirty-day and one-year mortality and major bleeding rates were similar between the 2 groups. Logistic regression identified male sex, radial access, negative troponin biomarker status, and procedure start time as predictors of SDD. In propensity-matched analyses, there was no difference in 30-day mortality and readmission between SDD and NDD groups. SDD after non-elective PCI for NSTE-ACS may be a reasonable alternative to NDD for selected low-risk patients with comparable mortality, bleeding, and readmission rates.