Same-day Discharge Following Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Background: Over the past decade, significant advancements in percutaneous coronary intervention (PCI) have substantially reduced periprocedural complications. These developments have also made same-day discharge (SDD) following PCI increasingly feasible. This study aims to provide the most up-to-date evidence on the safety of SDD through a synthesis of randomised controlled trial (RCT) results. Methods: We systematically searched the PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases for RCTs comparing the safety of SDD versus overnight stay (ONS) following PCI. Meta-analyses were conducted using a random effects model. Results: A total of 14 RCTs comprising 3,215 patients (1,608 in the SDD group and 1,607 in the ONS group), primarily with chronic coronary syndrome or low-risk acute coronary syndrome, were included. Our meta-analysis demonstrated that SDD is as safe as ONS, as indicated by the comparable risks of adverse events, including major adverse cardiovascular events (pooled RR 0.76; 95% CI [0.46-1.27]), major bleeding (pooled RR 1.29; 95% CI [0.50-3.37]), vascular complications related to the access site (pooled RR 1.06; 95% CI [0.78-1.45]), rehospitalisation (pooled RR 1.15; 95% CI [0.79-1.68]) and unplanned hospital visits (pooled RR 1.02; 95% CI [0.73-1.42]) within 30 days post-PCI. The results remained robust, regardless of access site, timing of discharge or clinical presentation (all p for interaction >0.05). Conclusion: This up-to-date meta-analysis provides strong evidence supporting the safety of SDD compared with ONS after PCI. Further well-designed RCTs involving high-risk acute coronary syndrome patients are warranted to further clarify the safety of the SDD strategy in this population.