Same-day Discharge Following Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomised...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Percutaneous coronary intervention (PCI) has seen significant advancements, reducing complications.
• These advancements make same-day discharge (SDD) after PCI increasingly feasible.
• Evidence on SDD safety needs regular updating.

Purpose of the Study:

• To synthesize the latest randomized controlled trial (RCT) evidence on the safety of SDD versus overnight stay (ONS) following PCI.
• To provide an up-to-date assessment of SDD safety in current clinical practice.

Main Methods:

• Systematic literature search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov.
• Inclusion of 14 RCTs with 3,215 patients comparing SDD and ONS post-PCI.
• Meta-analysis using a random effects model to pool safety outcomes.

Main Results:

• SDD is comparable to ONS in safety, with similar rates of major adverse cardiovascular events (pooled RR 0.76; 95% CI [0.46-1.27]).
• No significant differences were observed in major bleeding (pooled RR 1.29; 95% CI [0.50-3.37]), vascular complications (pooled RR 1.06; 95% CI [0.78-1.45]), rehospitalisation (pooled RR 1.15; 95% CI [0.79-1.68]), or unplanned visits (pooled RR 1.02; 95% CI [0.73-1.42]) within 30 days.
• Results were consistent across different access sites, discharge timings, and patient clinical presentations.

Conclusions:

• Current meta-analysis provides strong evidence supporting the safety of SDD compared to ONS after PCI.
• SDD is a safe strategy for patients undergoing PCI, particularly those with chronic coronary syndrome or low-risk acute coronary syndrome.
• Further RCTs are needed to evaluate SDD safety in high-risk acute coronary syndrome patients.