Association of Acute Kidney Injury Risk and Same-Day Discharge Practices After Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Nephrology
• Health Services Research

Background:

• Same-day discharge (SDD) after percutaneous coronary intervention (PCI) is increasingly common but may be affected by procedural complications.
• Acute kidney injury (AKI) is a frequent complication following PCI, potentially impacting SDD decisions.

Purpose of the Study:

• To investigate the association between the risk of acute kidney injury (AKI) and the practice of same-day discharge (SDD) after percutaneous coronary intervention (PCI).
• To assess trends and variations in SDD rates based on AKI risk and healthcare site.

Main Methods:

• Utilized the National Cardiovascular Data Registry (NCDR) CathPCI registry data from 2018-2022 for elective PCIs.
• Calculated AKI risk using the NCDR prediction model and employed hierarchical logistic regression to predict SDD.
• Analyzed trends in SDD rates across AKI risk categories and quantified site variability using median odds ratios (ORs).

Main Results:

• Over 1 million PCIs were analyzed; 40.1% of patients were discharged the same day, with rates increasing from 27.9% in 2018 to 53.4% in 2022.
• Higher AKI risk was associated with lower SDD rates (OR 0.97 per 1% increase), yet 41.2% of high-risk patients had SDD in 2022.
• Significant variation in SDD practices was observed across sites, even for high-risk patients (median OR 3.60).

Conclusions:

• While higher AKI risk reduces SDD likelihood, a substantial proportion of high-risk patients (2 in 5 with >10% risk) are still discharged same-day.
• Marked inter-site variability in SDD practices for high-risk patients necessitates further investigation.
• Improved understanding of post-discharge risks for AKI patients is crucial for optimizing PCI delivery and safety.