Same-day discharge following elective PCI was noninferior to next-day discharge for 30-day readmission and associated with lower 1-year mortality (aOR 0.20; 95% CI 0.05-0.81; p=0.024).
Observational (n=2,099)
No
Does same-day discharge compared to next-day discharge improve outcomes in patients undergoing outpatient elective PCI in a rural population?
Same-day discharge following elective PCI in a largely rural population is safe, with no increase in 30-day readmissions and lower long-term mortality compared to next-day discharge.
Effect estimate: aOR 0.20 (95% CI 0.05-0.81)
p-value: p=0.024
BACKGROUND: Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is safe, yet the nationwide rate of SDD remains low. The impact that residing in a rural area has on the safety of SDD is unknown. OBJECTIVE: To investigate the safety of SDD compared to next-day discharge (NDD) among PCI patients living in a largely rural area. METHODS: There were 3502 outpatient elective PCIs at a tertiary care center between January 1, 2011 and December 31, 2017. Data from the National Cardiovascular Data Registry CathPCI Registry® and the electronic medical records were obtained for patient demographics, procedural characteristics, and procedural outcomes. Data from the initial PCI in each 365-day period were included in the analysis for each patient. Rural-Urban Commuting Area codes 4-10 were used to define rural status. RESULTS: A total of 2099 (59.9%) PCIs met the inclusion criteria (63% rural). The overall rate of SDD increased over time (4.7% in 2011 to 39.6% in 2017) as radial access increased (14.2% in 2011 to 59.9% in 2017). In this population, a total of 329 PCIs had SDD (15.7%; median (interquartile range) age 66.0 (14.0) years, 20.1% female, 52.3% rural status). Compared to NDD, SDD patients had less hyperlipidemia, atrial fibrillation, congestive heart failure, history of coronary artery bypass graft, and more radial access. SDD was noninferior to NDD for 30-day readmission but had a decreased 1-year (adjusted odds ratio aOR: 0.20, 95% confidence interval CI: 0.05-0.81, p = 0.024) and 5-year (aOR: 0.43, 95% CI: 0.28-0.66, p < 0.001) all-cause mortality compared to NDD. Rural status did not predict outcomes. CONCLUSIONS: SDD in patients in rural areas does not have a significantly higher rate of 30-day readmission. SDD patients had lower odds of 1- and 5-year mortality when compared to NDD. Future studies prospectively evaluating the safety of SDD in this population are warranted.
Ginete et al. (Sat,) conducted a observational in Elective percutaneous coronary intervention (n=2,099). Same-day discharge (SDD) vs. Next-day discharge (NDD) was evaluated on 1-year all-cause mortality (aOR 0.20, 95% CI 0.05-0.81, p=0.024). Same-day discharge following elective PCI was noninferior to next-day discharge for 30-day readmission and associated with lower 1-year mortality (aOR 0.20; 95% CI 0.05-0.81; p=0.024).