Same-day discharge after percutaneous coronary intervention: a meta-analysis

Abstract

Objectives: This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI).

Background: The safety of same-day discharge has previously been evaluated primarily in small, single-center studies.

Methods: We 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 pre-specified: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications.

Results: Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCTs) (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 (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (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%).

Conclusions: 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.

Keywords: ACS; CAD; MI; PCI; RCT; TLR; acute coronary syndrome; coronary artery disease; myocardial infarction; percutaneous coronary intervention; randomized controlled trial; same-day discharge; target lesion revascularization.

Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.