Chronic CAD/Stable Ischemic Heart Disease

E1132JACC March 12, 2013Volume 61, Issue 10

same-day discharge afTer percuTaneous coronary inTervenTion: a meTa-analysis

Oral ContributionsWest, Room 3014Saturday, March 09, 2013, 9:15 a.m.-9:30 a.m.

Session Title: The Cutting Edge in Revascularization for SIHDAbstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: ClinicalPresentation Number: 910-8

Authors: Kimberly Brayton, Vishal Patel, James de Lemos, Dharam Kumbhani, Stanford University, Stanford, CA, USA, UT Southwestern, Dallas, TX, USA

Background: The safety of same-day discharge after percutaneous coronary intervention (PCI) has been evaluated in small, single-center studies. We performed a meta-analysis to assess outcomes of same-day discharge in a range of practice settings.

methods: 37 studies were included for analysis. Demographics, procedural characteristics, and outcome variables including death, myocardial infarction (MI), target lesion revascularization (TLR), stroke, bleeding, vascular complications, and readmission were collected. Primary study endpoints were a composite of death/MI/TLR and a composite of major bleeding/vascular complications.

results: We included 7 randomized trials (RCT)(2,738 patients) and 30 observational studies (10,065 patients). Mean age was 60.9 (RCT) and 62.4 years (observational). Most patients underwent PCI for stable angina (66.4% RCT, 97.5% observational). Primary access was predominantly transradial in RCT (60.8%) and transfemoral in observational cohort (70.0%). In RCT, there was no difference between groups in primary or secondary endpoints (Table 1). In observational studies, the primary endpoint death/MI/TLR occurred at a pooled rate of 1.00% (95% Confidence Interval (CI) 0.58-1.68) and major bleeding/vascular complications at a pooled rate of 0.68% (95% CI 0.35-1.32).

conclusion: Same-day discharge after PCI is associated with a low rate of major complications, and appears as safe as routine overnight observation in selected patients.