TY - JOUR
T1 - Same-day discharge after percutaneous coronary intervention
T2 - A meta-analysis
AU - Brayton, Kimberly M.
AU - Patel, Vishal G.
AU - Stave, Christopher
AU - de Lemos, James A
AU - Kumbhani, Dharam J
N1 - Funding Information:
Research by Dr. Brayton is supported by grant no. HS000028 from the National Institutes of Health . The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the AHRQ. Dr. de Lemos has received honoraria from AstraZeneca, consultant's fees from The sanofi-aventis Group and Daiichi Sankyo. Dr. Kumbhani has received honoraria from the American College of Cardiology and Somahlutions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/7/23
Y1 - 2013/7/23
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.
KW - percutaneous coronary intervention
KW - same-day discharge
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U2 - 10.1016/j.jacc.2013.03.051
DO - 10.1016/j.jacc.2013.03.051
M3 - Article
C2 - 23623905
AN - SCOPUS:84880301984
SN - 0735-1097
VL - 62
SP - 275
EP - 285
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -