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Same-day discharge after large-bore access in percutaneous coronary intervention of chronic total coronary occlusions
Yvemarie B O Somsen1, Adriaan Wilgenhof2,3, Roel Hoek1
1Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Insights
Same-day discharge is feasible for most patients undergoing chronic total occlusion percutaneous coronary intervention with large-bore access. This approach demonstrates safety, with similar low readmission and major adverse cardiovascular event rates compared to traditional discharge.
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.
Background:
Same-day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) is appealing because of the increased patient comfort. However, data on SDD following large-bore vascular access are scarce.
Aims:
We investigated the feasibility and safety of SDD in patients undergoing large-bore CTO PCI.
Methods:
Between 2013 and 2023, 948 patients were prospectively enrolled in a single-centre CTO registry and underwent CTO PCI. SDD was pursued in all patients. Large-bore access was defined as the use of ≥7 French (Fr) sheaths in ≥1 access site. A logistic regression analysis was used to identify predictors for non-SDD. Clinical follow-up was obtained at 30 days.
Results:
SDD was observed in 62% of patients. Large-bore access was applied in 99% of the cohort. SDD patients were younger and more often male, with lower rates of renal insufficiency and prior coronary artery bypass grafting. Local access site bleeding (odds ratio [OR] 8.53, 95% confidence interval [CI]: 5.24-13.87) and vascular access complications (OR 7.23, 95% CI: 1.98-26.32) made hospitalisation more likely, with vascular access complications occurring in 3%. At 30 days, the hospital readmission rate was low in both SDD and non-SDD patients (5% vs 7%; p=non-significant). Finally, SDD was not a predictor for major adverse cardiovascular events (MACE) at follow-up.
Conclusions:
Same-day discharge can be achieved in the majority of patients undergoing CTO PCI with large-bore (≥7 Fr) access. Similar low hospital readmission and MACE rates between SDD and non-SDD patients at 30 days demonstrate the feasibility and safety of SDD.
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