COED PCI Assesses Same-Day Discharge After Elective PCI

January 1, 2013—Purushothaman Muthusamy, MD, et al published results of the COED-PCI study in Catheterization and Cardiovascular Interventions (2013;81:6–13). COED-PCI was conducted to assess clinical outcomes of same-day discharge (SDD) patients after elective percutaneous coronary intervention (PCI).

From this single-center study, the investigators concluded that their institution-specific guidelines identify low-risk PCI patients who can safely be considered candidates for SDD with virtually no short-term adverse consequences. The study was conducted at the Frederik Meijer Heart & Vascular Institute, Spectrum Health in Grand Rapids, Michigan.

The investigators stated that the background of the study is that an overnight stay after PCI has been the standard approach in the majority of institutions, and that data supporting SDD while maintaining patient safety, based on contemporary United States practice, have not been well established.

As summarized in Catheterization and Cardiovascular Interventions, the investigators used institutional preprocedural, periprocedural, and postprocedural guidelines to prospectively study short-term clinical outcomes of 200 consecutive patients discharged on the same day after elective PCI. Major adverse cardiac events (MACE), access site and vascular complications, readmissions, and emergency room visits were assessed within 24 hours and at 7 days after SDD. MACE included cerebral vascular accidents, death, myocardial infarction, target vessel revascularization, pulmonary embolism, and emergent coronary artery bypass grafting.

The mean age of the population was 63.2 years; 75% were males. Of 200 patients, 75.5% were treated via femoral access and 24.5% were treated via radial access. Intraprocedural anticoagulation included bivalirudin alone (47%), bivalirudin with glycoprotein IIb/IIIa inhibitors (3.5%), heparin alone (37%), and heparin with glycoprotein IIb/IIIa inhibitors (12.5%).

There were no major bleeding or MACE reported within 24 hours or at 7 days. Within 7 days, eight (4%) patients experienced minor bleeding, four (2%) patients were readmitted, and three (1.5%) patients had emergency room visits only. Pseudoaneurysm occurred in one (0.5%) patient, reported the investigators in Catheterization and Cardiovascular Interventions.