Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes
Hariri E, Kassas I, Hammoud MA, et al. Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes. Am Heart J. 2022;246:125-135. doi:10.1016/j.ahj.2021.12.015
Background and aim: Timing of discharge after percutaneous coronary intervention (PCI) is a crucial aspect of procedural safety and patient turnover. We examined predictors and outcomes of same-day discharge (SDD) after non-elective PCI for non-ST elevation acute coronary syndromes (NSTE-ACS) in comparison with next-day discharge (NDD).
Methods: Baseline demographic, clinical, and procedural data were as well as in-hospital outcomes and post-PCI length of stay (LOS) were collected for all patients undergoing non-elective PCI for NSTE-ACS between 2011 and 2014 at a central tertiary care center. Thirty day and 1-year mortality and bleeding as well as 30-day readmission rates were determined from social security record and medical chart review. Logistic regression was performed to identify predictors of SDD, and propensity-matched analysis was done to examine the differences in outcomes between NDD and SDD.
Results: Out of 2,529 patients who underwent non-elective PCI for NSTE-ACS from 2011-2014, only 1,385 met the inclusion criteria (mean age = 63 years; 26% women) and were discharged either the same day of (N=300) or the day after (N=1085). Thirty-day and one-year mortality and major bleeding rates were similar between the two groups. Logistic regression identified male sex, radial access, negative troponin biomarker status, and procedure start time as predictors of SDD. In propensity-matched analyses, there was no difference in 30-day mortality and readmission between SDD and NDD groups.
Conclusions: SDD after non-elective PCI for NSTE-ACS may be a reasonable alternative to NDD for selected low-risk patients with comparable mortality, bleeding, and readmission rates.