Outcomes of Patients Discharged the Same Day Following Percutaneous Coronary Intervention

• Published in: JACC. Cardiovascular interventions 2010-08, Vol.3 (8), p.851-858
• Main Authors: Patel, Mehul, MD, Kim, Michael, MD, Karajgikar, Rucha, MBBS, Kodali, Visali, MD, Kaplish, Dheeraj, MBBS, Lee, Paul, MD, Moreno, Pedro, MD, Krishnan, Prakash, MD, Sharma, Samin K., MD, Kini, Annapoorna S., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Cardiovascular; Clinical Protocols; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; cost-saving; DES; Humans; Length of Stay; Middle Aged; New York City; Outcome and Process Assessment (Health Care) - statistics & numerical data; Patient Discharge - statistics & numerical data; percutaneous coronary intervention; Platelet Aggregation Inhibitors - therapeutic use; Registries; registry; Retrospective Studies; safety; same-day discharge; selection; Time Factors; Treatment Outcome
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2010.05.010

Objectives This study evaluated the outcomes of patients discharged the day of percutaneous coronary intervention (PCI) by analyzing the data from a single-center, large, multioperator registry of interventions. Background Although same-day discharge is likely safe after interventions on low-risk stable patients, there is limited data to guide selection of a broader population of patients. Due to numerous patient variables and physician preferences, standardization of the length of stay after PCI has been a challenge. Most of the reported studies on same-day discharge have strict inclusion criteria and hence do not truly reflect a real-world population. Methods We analyzed the outcomes of consecutive same-day discharge in 2,400 of 16,585 patients who underwent elective PCI without any procedural or hospital complication. Composite end point included 30-day major adverse cardiac cerebral events and bleeding/vascular complications. Results The mean age of the study population was 57.0 ± 23.7 years with 12% aged over 65 years. Twenty-eight percent received glycoprotein IIb/IIIa inhibitor with closure devices in 90.5%. Clinical and angiographic success was noted in 97% of all PCIs. The average length-of-stay following PCI was 8.2 ± 2.5 h. The composite end point was reached in 23 patients (0.96%). Major adverse cardiac cerebral events occurred in 8 patients (0.33%) and vascular/bleeding complications in the form of Thrombolysis In Myocardial Infarction minor bleeding in 14 patients (0.58%) and pseudoaneurysm in 1 patient (0.04%). Conclusions When appropriately selected, with strict adherence to the set protocol, same-day discharge after uncomplicated elective PCI is safe despite using femoral access in a wide spectrum of patients.