Key result
Short-time discharge (<24 hours) following uncomplicated percutaneous coronary intervention in NSTEMI patients was associated with a similar 30-day rate of net adverse clinical events compared to routine long-time discharge (8.6% vs. 11.6%, p=0.09).
Why the study?
The optimal length of stay following non-complicated PCI for NSTEMI remains controversial, and few studies have examined the impact of early discharge on short-term outcomes.
Does short-time discharge (< 24 hours) reduce or maintain the rate of 30-day net adverse clinical events compared to routine long-time discharge (2-3 days) in NSTEMI patients following uncomplicated PCI?
Cohort (n=1,424)
No
Does short-time discharge (< 24 hours) reduce or maintain the rate of 30-day net adverse clinical events compared to routine long-time discharge (2-3 days) in NSTEMI patients following uncomplicated PCI?
Absolute Event Rate: 8.6% vs 11.6%
p-value: p=0.09
Short-time discharge (< 24 hours) following uncomplicated PCI in selected NSTEMI patients is feasible and safe, yielding similar 30-day clinical outcomes compared to routine 2-3 day discharge.
Short-time discharge after uncomplicated PCI may be safe in selected NSTEMI patients; leaves open need for randomized confirmation before practice change.
BACKGROUND: The rational length of stay following non-complicated percutaneous coronary intervention (PCI) for Non-ST elevation myocardial infarction (NSTEMI) patients remains controversial. Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients, but short-time discharge is not uncommon in real world practice. This study examined the impact of short time discharge following non-complicated PCI on 30-day net adverse clinical events in NSTEMI patients. METHODS: This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI. Of these patients, 432 were discharged early (< 24 h), whereas the remaining 992 NSTEMI patients underwent routine discharge. The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days. The differences between the two groups were analyzed after propensity score matching to reduce selection bias. RESULTS: The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6% (115/992) compared with 8.6% (37/432) in the short-time discharge group, although this difference was not significant (P = 0.09). This difference was mainly due to lesser radial access selected in the long-time discharge group (827/932, 83.4% vs. 387/432, 89.5%, P < 0.0005). After PS matching to balance the access difference, there was no significant difference in the incidence of the events mentioned above between two groups. CONCLUSIONS: If an NSTEMI patient undergoes PCI without any procedural or hospital complications, short-time discharge after successful PCI would be feasible and safe in selected NSTEMI patients.
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Guo-zhong et al. (2019) conducted a cohort in Non-ST elevation myocardial infarction (NSTEMI) (n=1,424). Short-time discharge (< 24 h) vs. Long-time discharge (2-3 days) was evaluated on 30-day net adverse clinical events (major adverse cardiac or cerebral events or access site vascular/bleeding complications) (95% CI 0.49-1.05, p=0.09). Short-time discharge (<24 hours) following uncomplicated percutaneous coronary intervention in NSTEMI patients was associated with a similar 30-day rate of net adverse clinical events compared to routine long-time discharge (8.6% vs. 11.6%, p=0.09).
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