Same-day discharge after PCI is safe

General

Clinical Question:
Is same-day discharge after percutaneous coronary intervention safe and feasible?

Bottom Line:
For patients meeting discharge criteria 4 hours after observation, same-day discharge following elective percutaneous coronary intervention (PCI) is safe. However, this practice would not be applicable in centers where glycoprotein IIb/IIIa inhibitors are administered for 12 hours following PCI. (LOE = 1b)

Reference:
Heyde GS, Koch KT, de Winter RJ, et al. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention. Results of the Elective PCI in Outpatient Study (EPOS). Circulation 2007;115:2299-2306.  [PMID:17420341]

Study Design:
Randomized controlled trial (nonblinded)

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
This trial included outpatients scheduled for elective PCI, but not those scheduled to undergo diagnostic coronary catheterization with possible PCI. Patients receiving glycoprotein IIb/IIIa receptor blockers and treatment with long-term systemic anticoagulation were excluded. Patients were randomized to either be discharged on the same day as PCI or to stay overnight at the hospital. Directly following PCI, patients with predefined complications, including coronary artery occlusion, dissection, perforation, chest pain, and electrocardiogram changes, were identified for extended monitoring and observation. In the absence of complications, patients were observed for 4 hours, then ambulated and evaluated for discharge. After discharge evaluation, the randomization was revealed and patients were either discharged or transferred for overnight stay. All patients received aspirin, preprocedure heparin, and clopidogrel, if stents were used. Patients were followed up by phone at 1 day, 3 days, and 30 days. The angiographers and clinicians evaluating patients for discharge were blinded to treatment group assignment. Of 1453 elective PCIs, 800 patients met inclusion criteria. Multilesion and complex lesion PCIs were common. Ninety-four percent of patients had successful PCI. Nineteen percent of patients in the same-day discharge group developed an indication for extended stay either directly following PCI (17%) or during the 4-hour observation period (2%). The primary end point, a composite of major adverse cardiac and cerebral events and severe complications of arterial puncture (need for blood transfusion or repeat compression for 24 hours following PC), occurred in 2.2% of same-day discharge and 4.2% of overnight stay patients (risk difference = -0.02; 95% CI, -0.045 to -0.004; P < .0001 for noninferiority). Only one of these events occurred in a patient who was assigned to same-day discharge and was actually discharged after 4 hours; the other patients had been identified as unsuitable for discharge. Adverse events rates were similar between groups at 30-day follow-up.

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