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Same day discharge versus overnight observation following chronic total occlusion percutaneous coronary intervention:

Bahadir Simsek1, Jaikirshan Khatri2, Laura Young2

  • 1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 24, 2023
PubMed

Insights

Same day discharge (SDD) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is increasingly feasible, with radial-only access strongly associated with SDD. This approach is safe for select patients, showing low readmission rates.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Same day discharge (SDD) following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been understudied.
  • The Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) database provides insights into this practice.

Purpose of the Study:

  • To evaluate the clinical, angiographic, and procedural characteristics of patients undergoing CTO PCI with same day discharge versus overnight observation.
  • To identify factors associated with SDD after CTO PCI.

Main Methods:

  • Analysis of 7181 patients from the PROGRESS-CTO registry who underwent CTO PCI.
  • Comparison of patient characteristics, procedural success, and adverse events between SDD and overnight observation groups.
  • Multivariable logistic regression to identify predictors of SDD and overnight observation.

Main Results:

  • The SDD rate increased from 3% in 2015 to 21% in 2022, with 13% of patients discharged same day.
  • Patients undergoing SDD were less likely to have comorbidities like heart failure, chronic lung disease, or anemia.
  • Technical success was similar between groups, but in-hospital major adverse cardiovascular events were lower in the SDD group (0.0% vs. 0.4%).
  • Radial-only access was the strongest predictor of SDD (OR: 2.45), while prior myocardial infarction and chronic lung disease were associated with overnight observation.

Conclusions:

  • Same day discharge is feasible and increasingly utilized for select patients after CTO PCI.
  • Radial-only access is a key factor facilitating SDD in CTO PCI.
  • The study demonstrates a growing trend and safety profile for SDD in this patient population.
Abstract

Keywords:
chronic total occlusionovernight observationpercutaneous coronary interventionsame day discharge

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