OBJECTIVES: This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: The safety of same-day discharge has previously been evaluated primarily in small, single-center studies. METHODS: We conducted a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. Demographic data, procedural characteristics, and adverse outcomes were collected. Two composite outcomes were pre-specified: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications. RESULTS: Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCTs) (n = 2,738) and 30 observational studies (n = 10,065). The majority of patients in both cohorts underwent PCI for stable angina. The vascular access site was predominantly transradial in the randomized cohort (60.8%) and transfemoral in the observational cohort (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI: 0.58% to 1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35% to 1.32%). CONCLUSIONS: In selected patients undergoing largely elective PCI, same-day discharge was associated with a low rate of major complications and appeared to be as safe as routine overnight observation.
OBJECTIVES: This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: The safety of same-day discharge has previously been evaluated primarily in small, single-center studies. METHODS: We conducted a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. Demographic data, procedural characteristics, and adverse outcomes were collected. Two composite outcomes were pre-specified: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications. RESULTS: Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCTs) (n = 2,738) and 30 observational studies (n = 10,065). The majority of patients in both cohorts underwent PCI for stable angina. The vascular access site was predominantly transradial in the randomized cohort (60.8%) and transfemoral in the observational cohort (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI: 0.58% to 1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35% to 1.32%). CONCLUSIONS: In selected patients undergoing largely elective PCI, same-day discharge was associated with a low rate of major complications and appeared to be as safe as routine overnight observation.
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