Same-day discharge after large-bore access in percutaneous coronary intervention of chronic total coronary occlusions

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Access

Background:

• Same-day discharge (SDD) after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) offers patient comfort but lacks data for large-bore vascular access.
• Large-bore access (≥7 French sheaths) is increasingly used in complex PCI procedures like CTO interventions.

Purpose of the Study:

• To evaluate the feasibility and safety of same-day discharge (SDD) in patients undergoing large-bore chronic total occlusion percutaneous coronary intervention (CTO PCI).

Main Methods:

• A prospective, single-centre registry enrolled 948 patients undergoing CTO PCI between 2013 and 2023.
• Large-bore access was defined as ≥7 French sheath use. Logistic regression identified predictors for non-SDD.
• Clinical outcomes, including 30-day follow-up for readmission and major adverse cardiovascular events (MACE), were assessed.

Main Results:

• Same-day discharge (SDD) was achieved in 62% of patients, with 99% utilizing large-bore access.
• Factors associated with non-SDD included local bleeding and vascular access complications.
• Vascular access complications occurred in 3% of patients. Hospital readmission and MACE rates at 30 days were low and comparable between SDD and non-SDD groups.

Conclusions:

• Same-day discharge is achievable in the majority of patients undergoing large-bore CTO PCI.
• The safety of SDD is supported by similar low 30-day hospital readmission and MACE rates compared to non-SDD patients.