Outcomes of Same-Day Discharge in Chronic Total Occlusion Percutaneous Coronary Intervention

Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is increasingly used, yet data on its safety after chronic total occlusion PCI (CTO PCI) remain limited. We retrospectively analyzed all CTO PCI procedures performed at a single US center between 2019 and 2023, comparing patients discharged the same day with those who were not. The primary endpoint was 30-day major adverse cardiac and cerebrovascular events (MACCE) or rehospitalization. Analyses included multivariable Cox proportional hazards regression and recursive partitioning. Among 1,273 patients, 352 (27.6%) underwent SDD. SDD patients had lower co-morbidity burden (Charlson Comorbidity Index [CCI] 3.6 ± 3.1 vs 4.2 ± 2.8, p = 0.002) and better renal function (estimated glomerular filtration rate 78.6 ± 24.2 vs 73.7 ± 23.3 ml/min/1.73 m², p = 0.001). In-hospital, MACCE occurred in 0% of SDD versus 2.0% of non-SDD patients (p < 0.001). At 30 days, MACCE/rehospitalization was significantly lower in the SDD group (4.3% vs 7.9%, p = 0.021). Multivariable analysis identified body mass index (adjusted hazard ratio [aHR] 1.09; 95% confidence interval [CI] 1.02 to 1.16; p = 0.010), CCI (aHR 2.16; 95% CI 1.37 to 4.49; p = 0.003), and antegrade dissection and reentry use (aHR 1.86; 95% CI 1.09 to 3.34; p = 0.040) as independent correlates of 30-day adverse events, while SDD itself was not. A recursive partitioning model identified CCI, estimated glomerular filtration rate, and distance to the PCI center (driving miles) as the strongest discriminators of risk within the SDD cohort. In this large contemporary series, SDD after CTO PCI was safe and feasible in carefully selected patients. Comorbidity burden, renal function, procedural complexity, and patient geography may help guide SDD decision-making in modern CTO practice.