Early versus late clinical outcomes following same day discharge after elective percutaneous coronary intervention

Abstract

Background:Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI.Methods:The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software.Results:A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31–1.79; P = .51), mortality (OR: 0.26, 95% CI: 0.06–1.06; P = .06), stroke (OR: 1.46, 95% CI: 0.72–2.94; P = .29), arrhythmia (OR: 1.30, 95% CI: 0.64–2.63; P = .47), hematoma (OR: 1.00, 95% CI: 0.60–1.66; P = 1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22–12.85; P = .62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71–5.70; P = .19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86–50.66; P = .07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07–0.44; P = .0002).Conclusions:In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.

Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis

“…As indicated by the studies in this review, this estimate is likely to be even higher (although restricted to elective PCIs only) by increasing use of SDD. Lu et al [64] state that 57% of the interventionalists in the US practice SDD. These practice trends (switching over to the TRI/SDD pathway) need to therefore continue and be bolstered.…”

“…published in 2017 also demonstrated similar findings. In a recently published meta-analysis of 11 studies with 21,687 patients, Lu et al [64] have demonstrated that early and late clinical outcomes in patients discharged on the same day of PCI were comparable to those discharged after an overnight stay. While the clinical value of SDD is thus clearly established [65], the subsequent reductions in costs of PCI have not been systematically studied and are not clearly established.…”

Costs Associated With Transradial Access and Same-Day Discharge After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…As indicated by the studies in this review, this estimate is likely to be even higher (although restricted to elective PCIs only) by increasing use of SDD. Lu et al state 64 that 57% of the interventionists in the US practice SDD. These practice trends (switching over to the TRI/SDD pathway) need to therefore continue and be bolstered.…”

Same-day discharge after percutaneous coronary procedures—Consensus statement of the working group of interventional cardiology (AGIK) of the Austrian Society of Cardiology

“…As stated above, the Austrian Society of Cardiology has performed a systematic literature review and meta-analysis to substantiate its practice recommendations [ 14 ]. In short, four large meta-analyses have published outcome data for SDD PCI [ 19 – 22 ], summarizing 38,785 patients with SDD and 256,049 patients staying overnight. All four meta-analyses are consistent in demonstrating no added risk of SDD practice assessed by MACE at 24 h and/or 30 days.…”