Same-day discharge after elective percutaneous coronary intervention: Insights from the British Cardiovascular Intervention Society

Selected in JACC: Cardiovascular Interventions by S. Brugaletta

The aim of this study was to evaluate national temporal trends in same-day discharge (SDD) and compare clinical outcomes with those among patients admitted for overnight stay undergoing elective PCI for stable angina.

Reviewer

Salvatore Brugaletta

@sbrugaletta

Interventional cardiologist / Cardiologist

Barcelona, Spain

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My Comment

Why this study – the rationale/objective?

Overnight observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from health care systems in which same-day discharge (SDD) is the predominant practice for elective PCI. The aim of this study was to evaluate national temporal trends in same-day discharge (SDD) and compare clinical outcomes with those among patients admitted for overnight stay undergoing elective PCI for stable angina.

How was it executed – the methodology?

Data from 169,623 patients undergoing elective PCI between 2007 and 2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the British Cardiovascular Intervention Society risk model were used to study the association between SDD and 30-day mortality.

What is the main result?

The rate of SDD increased from 23.5% in 2007 to 57.2% in 2014, with center SDD median prevalence varying from 17% (interquartile range: 6% to 39%) in 2007 to 66% (interquartile range: 45% to 77%) in 2014. The largest independent association with SDD was observed for radial access (odds ratio: 1.69; 95% confidence interval: 1.65 to 1.74; p < 0.001). An increase in 30-day mortality rate over time for the SDD cases was observed, without exceeding the predicted mortality risk. According to the difference-in-differences analysis, observed 30-day mortality temporal changes did not differ between SDD and overnight stay (odds ratio: 1.15; 95% confidence interval: 0.294 to 4.475;
p =0.884).

Critical reading and relevance for clinical practice

The present study currently represents the largest analysis on SDD. SDD after PCI has been growing in the last years due to economical reasons. However, there was lack of data about this model of PCI and its safety. This analysis is the first showing how much this SDD-PCI model has been growing during the last years. It shows also an increasing PCI complexity in those patients considered for SDD. Despite this, SDD appears safe and it is not associated with increased risk of mortality up to 30-day after PCI.

These data are quite reassuring about feasibility and safety of SDD-PCI, even in patients with higher risk. This model of care, which has important economic implications for health care system, should be therefore implemented in every cath lab. A recent expert consensus from SCAI has been recently published, trying to standardize this process, based on procedural, patient and institutional factors.