Same-day-discharge ad hoc percutaneous coronary intervention: initial single-centre experience

Progress in techniques and equipment facilitates same-day-discharge percutaneous coronary intervention (PCI).

To present initial experience of a same-day-discharge intention-to-treat ad hoc PCI strategy with a preferentially radial approach.

The first 102 same-day-discharge PCIs performed in our centre were analysed retrospectively. Subjects were stable or stabilised coronary patients, free of cardiac insufficiency, with a normal Allen test and residing within 60min of the centre. Discharge was authorized after six hours' event-free monitoring. The principal assessment criterion combined major adverse cardiovascular events, stroke, major haemorrhage and unscheduled medical consultation in the 30 days following PCI. Overall patient satisfaction and anxiety associated with same-day discharge were assessed by telephone questionnaire at some time after the intervention.

Between January 2006 and March 2008, 95 day-hospital patients underwent 102 distinct PCIs (50 complex, 13 bifurcation lesions, nine intravascular ultrasound, 18 fractional flow reserve, two Rotablator procedures). Crossover to overnight admission was necessary for 5.9% (n=6) of interventions. Baseline clinical and angiographic characteristics were similar to those of an unselected Western population. At 30 days, four clinical events were observed (3.9% of interventions), which occurred within 6 hours (n=2) or after the 24th hour. Classical 24-hour admission would thus have provided no added benefit. On an analogue scale, overall satisfaction was high (8.9/10) and anxiety associated with same-day discharge was low (1.7/10).

A same-day-discharge ad hoc PCI strategy proved reliable and safe for most patients selected a priori on simple clinical criteria, entailing no unexpected complications due to shorter medical monitoring.