Same-day discharge after percutaneous coronary intervention: A meta-analysis

Kimberly M. Brayton, Vishal G. Patel, Christopher Stave, James A de Lemos, Dharam J Kumbhani

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)275-285
Number of pages11
JournalJournal of the American College of Cardiology
Volume62
Issue number4
DOIs
StatePublished - Jul 23 2013

Fingerprint

Percutaneous Coronary Intervention
Blood Vessels
Meta-Analysis
Confidence Intervals
Myocardial Infarction
Hemorrhage
Observational Studies
Randomized Controlled Trials
Odds Ratio
Observation
Safety
Stable Angina
Patient Discharge
Demography
Outcome Assessment (Health Care)

Keywords

  • percutaneous coronary intervention
  • same-day discharge

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Same-day discharge after percutaneous coronary intervention : A meta-analysis. / Brayton, Kimberly M.; Patel, Vishal G.; Stave, Christopher; de Lemos, James A; Kumbhani, Dharam J.

In: Journal of the American College of Cardiology, Vol. 62, No. 4, 23.07.2013, p. 275-285.

Research output: Contribution to journalArticle

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title = "Same-day discharge after percutaneous coronary intervention: A meta-analysis",
abstract = "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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AU - Patel, Vishal G.

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AU - Kumbhani, Dharam J

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N2 - 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.

AB - 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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