SCAI Updates Consensus Guideline on Length of Stay for PCI

April 30, 2018—The Society for Cardiovascular Angiography and Interventions announced the publication of revised guidelines on discharge criteria for patients undergoing elective percutaneous coronary intervention (PCI). Arnold Seto, MD, et al published the updated guidelines online in SCAI’s Catheterization and Cardiovascular Interventions.

The guidelines update SCAI's 2009 expert consensus document titled, “Defining the Length of Stay Following Percutaneous Coronary Intervention,” which specified that the standard of care was an overnight stay after uncomplicated, elective PCI and proposed that safeguarding patient welfare required length of stay (LOS) criteria be "dictated by a level of conservatism" in the absence of definitive studies.

According to SCAI, the updated guidelines incorporate new data and allow for flexibility in LOS while ensuring patient safety.

The guidelines include new criteria to assess readiness for discharge after PCI along three lines, including procedural (successful procedure, adequate hemostasis, and without complications), patient (clinically stable, at their baseline mental status and vital signs, and with stable comorbidities), and programmatic (safe monitoring at home, appropriate guideline-directed medical therapy, compliance with PCI performance measures, and timely follow-up).

Specific restrictions that previously precluded expedited discharge based on anatomic (ie, multivessel disease, bifurcations) or patient factors (ie, age, comorbidities) have been removed in the absence of evidence that overnight observation modifies the risk incurred.

The guidelines advise that advances in practices and technologies have made discharge after PCI demonstrably safe when milestones of clinical stability, procedural success, and process measures have been achieved. Ultimately, the duration of observation after PCI is a professional medical decision based on individual procedural and patient factors.

The updated consensus recommendations support the reasonable judgment of physicians to allow expedited discharge after PCI without prescribing a specific period of observation for individual patients, reported SCAI.