Key result
Same-day discharge post-PCI shows no difference in death, MI, or TLR versus overnight observation.
Why the study?
The safety of same-day discharge after PCI had previously been evaluated primarily in small, single-center studies.
Does same-day discharge after PCI safely prevent unnecessary hospital stays without increasing death, MI, TLR, or bleeding compared to routine overnight observation in patients undergoing PCI?
Meta-Analysis (n=12,803)
Yes
Does same-day discharge after PCI safely prevent unnecessary hospital stays without increasing death, MI, TLR, or bleeding compared to routine overnight observation in patients undergoing PCI?
Odds Ratio: 0.9 (95% CI 0.43–1.87)
p-value: p=0.78
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A lot of these same-day discharge protocols have been implemented in various hospitals around the country and around the world, but there hasn't been a single, summary document that really helps with implementation.”
“Same-Day Discharge enhances the patient experience without compromising safety. It also offers cost-saving benefits to our patients in terms of hospitalisation expenses, and helps us manage inpatient bed capacity more efficiently.”
Same-day discharge after largely elective PCI appears as safe as routine overnight observation, with low rates of major complications.
OBJECTIVES: This study sought to assess the safety of same-day discharge in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: The safety of same-day discharge has previously been evaluated primarily in small, single-center studies. METHODS: We conducted a meta-analysis of studies reporting outcomes of patients discharged on the same day as PCI. Demographic data, procedural characteristics, and adverse outcomes were collected. Two composite outcomes were pre-specified: 1) death, myocardial infarction (MI), or target lesion revascularization (TLR); and 2) major bleeding or vascular complications. RESULTS: Data from 12,803 patients in 37 studies were collated, including 7 randomized controlled trials (RCTs) (n = 2,738) and 30 observational studies (n = 10,065). The majority of patients in both cohorts underwent PCI for stable angina. The vascular access site was predominantly transradial in the randomized cohort (60.8%) and transfemoral in the observational cohort (70.0%). In the RCTs, no difference was seen between same-day discharge and routine overnight observation with regard to death/MI/TLR (odds ratio [OR]: 0.90; 95% confidence interval [CI]: 0.43 to 1.87; p = 0.78) or for major bleeding/vascular complications (OR: 1.69; 95% CI: 0.84 to 3.40; p = 0.15). In observational studies, the primary outcome of death/MI/TLR occurred at a pooled rate of 1.00% (95% CI: 0.58% to 1.68%), and major bleeding/vascular complications occurred at a pooled rate of 0.68% (95% CI: 0.35% to 1.32%). CONCLUSIONS: In selected patients undergoing largely elective PCI, same-day discharge was associated with a low rate of major complications and appeared to be as safe as routine overnight observation.
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Brayton et al. (2013) conducted a meta-analysis in Percutaneous coronary intervention (PCI) (n=12,803). Same-day discharge vs. Routine overnight observation was evaluated on Death, myocardial infarction (MI), or target lesion revascularization (TLR) (OR 0.90, 95% CI 0.43 to 1.87, p=0.78). Same-day discharge after largely elective PCI showed no significant difference in death, MI, or TLR compared to routine overnight observation in randomized trials (OR 0.90; 95% CI 0.43-1.87; p=0.78).
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