Key result
Same day discharge following percutaneous coronary intervention did not differ from overnight hospital stay in the incidence of major adverse cardiac events in patients with stable coronary artery disease.
Why the study?
Does same-day discharge reduce adverse cardiovascular outcomes compared to overnight stay in patients with stable CAD undergoing PCI?
Meta-Analysis (n=3,081)
Randomized
Yes
Does same-day discharge reduce adverse cardiovascular outcomes compared to overnight stay in patients with stable CAD undergoing PCI?
Same-day discharge following PCI in patients with stable CAD appears safe, with no significant increase in 30-day adverse cardiovascular outcomes compared to overnight hospital stay.
Answers are grounded in this paper and cite their sources.
Supports same-day discharge after PCI in stable CAD as comparably safe; extends RCT meta-analysis evidence for outpatient feasibility without excess events.
BACKGROUND: New research in interventional cardiology has shown the demand for percutaneous coronary interventions (PCI) to have increased tremendously. Effective treatment with a lower hospital cost has been the aim of several PCI capable centers. This study aimed to compare the adverse clinical outcomes associated with same day discharge versus overnight stay in the hospital following PCI in a population of randomized patients with stable coronary artery disease (CAD). METHODS: The National Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized Controlled Trials and EMBASE databases were searched (from March to June 2016) for randomized trials comparing same-day discharge versus overnight stay in the hospital following PCI. Main endpoints in this analysis included adverse cardiovascular outcomes observed during a 30-day period. Statistical analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CIs) were calculated with respect to a fixed or a random effects model. RESULTS: Eight randomized trials with a total number of 3081 patients (1598 patients who were discharged on the same day and 1483 patients who stayed overnight in the hospital) were included. Results of this analysis showed that mortality, myocardial infarction (MI) and major adverse cardiac events (MACEs) were not significantly different between same day discharge versus overnight stay following PCI with OR: 0.22, 95% CI: 0.04-1.35; P = 0.10, OR: 0.68, 95% CI: 0.33-1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20-1.02; P = 0.06 respectively. Blood transfusion and re-hospitalization were also not significantly different between these two groups with OR: 0.64, 95% CI: 0.13-3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88-2.65; P = 0.13 respectively. Similarly, any adverse event, major bleeding and repeated revascularization were also not significantly different between these two groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05-3.97; P = 0.45, OR: 0.73, 95% CI: 0.15-3.54; P = 0.69 and OR: 0.67, 95% CI: 0.14-3.15; P = 0.61 respectively. CONCLUSION: In terms of adverse cardiovascular outcomes, same day discharge was neither superior nor inferior to overnight hospital stay following PCI in those patients with stable CAD. However, future research will have to emphasize on the long-term consequences.
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Bundhun et al. (2017) conducted a meta-analysis in Stable coronary artery disease (n=3,081). Same day discharge following PCI vs. Overnight stay in the hospital following PCI was evaluated on Major adverse cardiac events (MACEs) (OR 0.45, 95% CI 0.20-1.02, p=0.06). Same day discharge following percutaneous coronary intervention did not differ from overnight hospital stay in the incidence of major adverse cardiac events in patients with stable coronary artery disease.
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