Same-day discharge in percutaneous coronary interventions: immediate results and short-term follow-up

Abstract

Although there is data on the feasibility of same-day discharge (SDD) of a percutaneous coronary intervention (PCI), overnight hospitalization (OH) remains the most common practice in our country. PCI in an outpatient setting could reduce logistical limitations in hospital resources, but data on this modality of care in our region are limited. Methods: 53 patients after uncomplicated and transradial PCI were randomized to SDD (group 1, n=26) or OH (group 2, n=27). The primary endpoint consisted of a combination of major adverse cardiovascular events (MACE) and severe puncture site complications, both of which occurred during the first 24 hours of PCI. In addition, three secondary end points were evaluated: a) costs, b) comfort and satisfaction, and c) the combination of MACE and complications of the puncture site from hospital discharge to 30 days post-PCI. Results: The mean age of the general population was 62 years, 47 (89%) men, 44 (83%) patients had elective PCI and 19 (36%) had unstable angina or myocardial infarction without ST segment elevation. The treated arteries were: a) LAD 17 (32%) patients, b) Cx 15 (28%), and c) RCA 14 (26%). Lesions B2/C were treated in 23 (43%) patients. One treated vessel per patient, stents per stenting procedure was 1 (1-3),
and 30 (57%) patients received drug-eluting stents. Patients in group 1 were hospitalized 12 h after PCI and 26 h those in the OH group (p<0.0001). No patient in both groups had any of the primary end points, 0% vs.0.0% respectively (p=0.99). The SDD group had a lower ICU cost than the OH group, 2016 vs. 4369 pesos respectively (p<0.001) as well as Coronary Unit costs, 1330 pesos in group 1 vs. 2881 pesos in group 2 (p<0.001). From the institutional discharge to the control day in follow-up, no patient in both groups had
any of the complications analyzed, 0% vs. 0% (p=0.99). Regarding the results of comfort and satisfaction, no statistically significant differences were found between both groups. Conclusions: Hospital discharge on the same day of a successful and transradial PCI is feasible, safe, cost-effective and generates excellent comfort in the majority of selected patients.