Study Supports Same-Day Discharge After PCI in Selected Patients

July 16, 2013—Findings from a meta-analysis of the safety of same-day discharge after percutaneous coronary intervention (PCI) were published by Kimberly M. Brayton, MD, et al in the Journal of the American College of Cardiology (JACC; 2013;62:275–285). The safety of same-day discharge has previously been evaluated primarily in small, single-center studies, noted the investigators.

As summarized in JACC, the investigators conducted a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. Demographic data, procedural characteristics, and adverse outcomes were collected. Two composite outcomes were prespecified: (1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and (2) major bleeding or vascular complications.

The investigators reported that data from 12,803 patients in 37 studies were collated, including seven randomized controlled trials (n = 2,738) and 30 observational studies (n = 10,065). The majority of patients in both cohorts 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%).

In the randomized controlled trials, the investigators found no difference between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio: 0.9; 95% confidence interval [CI]: 0.43 to 1.87; P = .78) or for major bleeding/vascular complications (odds ratio: 1.69; 95% CI: 0.84 to 3.4; P = .15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1% (95% CI: 0.58% to 1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35% to 1.32%).

In selected patients undergoing largely elective PCI, same-day discharge was associated with a low rate of major complications and appeared to be as safe as routine overnight observation, concluded the investigators.