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Published on: May 28, 2019
Outcomes of patients discharged the same day following percutaneous coronary intervention
Mehul Patel1, Michael Kim, Rucha Karajgikar
1Cardiac Catheterization Laboratory of the Zena and Michael A Weiner Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6754, USA.
Insights
Same-day discharge after uncomplicated elective percutaneous coronary intervention (PCI) is safe for a broad patient group when protocols are strictly followed. This approach minimizes major adverse cardiac cerebral events and bleeding complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Limited data exists on same-day discharge after percutaneous coronary intervention (PCI) for broader patient populations beyond low-risk individuals.
- Standardizing length of stay after PCI is challenging due to patient variables and physician preferences.
- Previous studies often use strict inclusion criteria, not reflecting real-world scenarios.
Purpose of the Study:
- To evaluate the safety and outcomes of same-day discharge following elective percutaneous coronary intervention (PCI).
- To analyze data from a large, multioperator registry to assess outcomes in a real-world patient population.
Main Methods:
- Analysis of outcomes for 2,400 patients discharged the same day after elective PCI from a single-center registry.
- Inclusion of patients without procedural or hospital complications.
- Composite endpoint analysis included 30-day major adverse cardiac cerebral events and bleeding/vascular complications.
Main Results:
- The study included 2,400 patients with an average age of 57.0 years; 12% were over 65.
- Clinical and angiographic success rates were 97%, with an average length of stay of 8.2 hours.
- The composite endpoint occurred in 0.96% of patients, with major adverse cardiac cerebral events in 0.33% and bleeding complications in 0.58%.
Conclusions:
- Same-day discharge after uncomplicated elective PCI is safe for a wide spectrum of patients when selected appropriately and protocols are strictly followed.
- Femoral access can be safely utilized in patients discharged the same day post-PCI.
- This approach demonstrates a low rate of adverse events in a real-world setting.
Objectives:
This study evaluated the outcomes of patients discharged the day of percutaneous coronary intervention (PCI) by analyzing the data from a single-center, large, multioperator registry of interventions.
Background:
Although same-day discharge is likely safe after interventions on low-risk stable patients, there is limited data to guide selection of a broader population of patients. Due to numerous patient variables and physician preferences, standardization of the length of stay after PCI has been a challenge. Most of the reported studies on same-day discharge have strict inclusion criteria and hence do not truly reflect a real-world population.
Methods:
We analyzed the outcomes of consecutive same-day discharge in 2,400 of 16,585 patients who underwent elective PCI without any procedural or hospital complication. Composite end point included 30-day major adverse cardiac cerebral events and bleeding/vascular complications.
Results:
The mean age of the study population was 57.0 +/- 23.7 years with 12% aged over 65 years. Twenty-eight percent received glycoprotein IIb/IIIa inhibitor with closure devices in 90.5%. Clinical and angiographic success was noted in 97% of all PCIs. The average length-of-stay following PCI was 8.2 +/- 2.5 h. The composite end point was reached in 23 patients (0.96%). Major adverse cardiac cerebral events occurred in 8 patients (0.33%) and vascular/bleeding complications in the form of Thrombolysis In Myocardial Infarction minor bleeding in 14 patients (0.58%) and pseudoaneurysm in 1 patient (0.04%).
Conclusions:
When appropriately selected, with strict adherence to the set protocol, same-day discharge after uncomplicated elective PCI is safe despite using femoral access in a wide spectrum of patients.
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