OBJECTIVES: This study sought to evaluate outcomes of same-day discharge (SDD) following percutaneous coronary intervention (PCI) versus overnight hospitalization (ON). BACKGROUND: Although there are data on the safety and feasibility of SDD after PCI, ON continues to be prevalent. METHODS: The Cochrane search strategy was used to search the PubMed database, EMBASE, and the Cochrane Library for relevant literature. Thirteen studies (5 randomized and 8 observational) of SDD after uncomplicated PCI versus ON met inclusion criteria. Data were pooled using a random effects model, and reported as odds ratios (OR) with their 95% confidence intervals (CI). The primary outcomes were incidence of total complications, major adverse cardiovascular events (MACE), and rehospitalization within 30 days after PCI. RESULTS: A total of 13 studies, involving 111,830 patients were pooled. There was significant variation in the definition of outcomes across studies. For total complications, the strategy of SDD compared with ON after PCI had an estimated OR of 1.20 (95% CI: 0.82 to 1.74) in randomized and 0.67 (95% CI: 0.27 to 1.66) in observational studies. Similar results were found for MACE (randomized, OR: 0.99, 95% CI: 0.45 to 2.18; observational, OR: 0.59, 95% CI: 0.06 to 5.57) and rehospitalizations (randomized, OR: 1.10, 95% CI: 0.70 to 1.74; observational, OR: 0.62, 95% CI: 0.10 to 3.98) at 30 days post PCI. CONCLUSIONS: There is considerable heterogeneity across published studies comparing SDD with ON. This, coupled with the low event rate and wide corresponding CIs, suggest that an adequately powered multicenter randomized trial comparing SDD with ON would require a very large sample size (>17,000). Until such a trial is completed, SDD after uncomplicated PCI seems a reasonable approach in selected patients.
OBJECTIVES: This study sought to evaluate outcomes of same-day discharge (SDD) following percutaneous coronary intervention (PCI) versus overnight hospitalization (ON). BACKGROUND: Although there are data on the safety and feasibility of SDD after PCI, ON continues to be prevalent. METHODS: The Cochrane search strategy was used to search the PubMed database, EMBASE, and the Cochrane Library for relevant literature. Thirteen studies (5 randomized and 8 observational) of SDD after uncomplicated PCI versus ON met inclusion criteria. Data were pooled using a random effects model, and reported as odds ratios (OR) with their 95% confidence intervals (CI). The primary outcomes were incidence of total complications, major adverse cardiovascular events (MACE), and rehospitalization within 30 days after PCI. RESULTS: A total of 13 studies, involving 111,830 patients were pooled. There was significant variation in the definition of outcomes across studies. For total complications, the strategy of SDD compared with ON after PCI had an estimated OR of 1.20 (95% CI: 0.82 to 1.74) in randomized and 0.67 (95% CI: 0.27 to 1.66) in observational studies. Similar results were found for MACE (randomized, OR: 0.99, 95% CI: 0.45 to 2.18; observational, OR: 0.59, 95% CI: 0.06 to 5.57) and rehospitalizations (randomized, OR: 1.10, 95% CI: 0.70 to 1.74; observational, OR: 0.62, 95% CI: 0.10 to 3.98) at 30 days post PCI. CONCLUSIONS: There is considerable heterogeneity across published studies comparing SDD with ON. This, coupled with the low event rate and wide corresponding CIs, suggest that an adequately powered multicenter randomized trial comparing SDD with ON would require a very large sample size (>17,000). Until such a trial is completed, SDD after uncomplicated PCI seems a reasonable approach in selected patients.
Authors: Amit P Amin; Duane Pinto; John A House; Sunil V Rao; John A Spertus; Mauricio G Cohen; Samir Pancholy; Adam C Salisbury; Mamas A Mamas; Nathan Frogge; Jasvindar Singh; John Lasala; Frederick A Masoudi; Steven M Bradley; Jason H Wasfy; Thomas M Maddox; Hemant Kulkarni Journal: JAMA Cardiol Date: 2018-11-01 Impact factor: 14.676
Authors: Kun Yun Lee; Tiong Kiam Ong; Ee Vien Low; Siow Yen Liow; Lawrence Anchah; Syuhada Hamzah; Houng Bang Liew; Rosli Mohd Ali; Omar Ismail; Wan Azman Wan Ahmad; Mas Ayu Said; Maznah Dahlui Journal: BMJ Open Date: 2017-05-28 Impact factor: 2.692
Authors: Kun Yun Lee; Wan Azman Wan Ahmad; Ee Vien Low; Siow Yen Liau; Lawrence Anchah; Syuhada Hamzah; Houng-Bang Liew; Rosli B Mohd Ali; Omar Ismail; Tiong Kiam Ong; Mas Ayu Said; Maznah Dahlui Journal: PLoS One Date: 2017-09-05 Impact factor: 3.240