Same-Day Discharge After Percutaneous Coronary Intervention: A Meta-Analysis

Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ.

OBJECTIVES: 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 prespecified: death, myocardial infarction (MI), or target lesion revascularization (TLR); and major bleeding or vascular complications RESULTS: Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCT) (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 (OR: 0.90; 95% CI: 0.47wQbNPTDJp9hMYdvogK2hAUiHsGeiybwaWe36bwtRQ3UTpYV7YuZ8FV5j9nauFCWwcjM6dTzpL5s2N79Rp5unwdMvc8ZKU.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI: 0.58-1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35-1.32%). CONCLUSIONS: In selected patients undergoing largely elective PCI, same-day discharge is associated with a low rate of major complications and appears to be as safe as routine overnight observation.

J Am Coll Cardiol. 2013 Apr 23. pii: S0735-1097 13)01588-X. [Epub ahead of print]