Why the study?
Does early discharge compared with ordinary discharge improve safety and reduce costs in patients undergoing PCI?
Does early discharge compared with ordinary discharge improve safety and reduce costs in patients undergoing PCI?
Early discharge after PCI appears safe and reduces costs by 655 Euros per patient compared with ordinary discharge, though it may increase rehospitalization risk in certain subgroups.
Early discharge after PCI reduces composite events and costs; extends RCT evidence supporting adoption in selected patients.
AIM: We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies. METHODS: The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days. RESULTS: For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52-0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88-1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge. CONCLUSION: The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
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Abdelnoor et al. (2017) studied this question.
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