A new study, published in Catheterization and Cardiovascular Interventions, indicates that patients with stable coronary artery disease who are treated with transradial percutaneous coronary intervention can be discharged the same day as receiving the intervention without increasing the risk of complications
Philippe Le Corvoisier, Hôpital Henri Mondor, Centre d’Investigation Clinique, Créteil, France, and others wrote that same-day discharge, or ambulatory, percutaneous coronary intervention (PCI) in patients with stable coronary artery disease may be feasible because dual antiplatelet therapy has decreased the incidence of stent thrombosis and because subacute stent thrombosis usually occurs several days after the procedure (thus, a 24-hour hospital stay would not modify this outcome). However, they commented: “The safety of same-day discharge after PCI needs to be clearly established before this method can be applied in daily practice. To date, few large-scales prospective studies have evaluated the feasibility and safety of this new patient management strategy.” They added in most of the previous studies that have assessed ambulatory PCI, many of the patients were hospitalised at least a day before the procedure. Le Corvoisier et al wrote: “Our study was one of the first in which patients were admitted and discharged on the day of the PCI.”
Ambulatory PCI management, as described by the authors of the study, involved patients being transferred to a hospital day unit after a transradial PCI procedure and being allowed to walk freely after two hours of bed rest. Four to six hours after the PCI, following a ECG and a clinical examination, patients were cleared for discharge if they had no puncture site complications, chest pain, or ECG changes during the observation period.
Of the 220 patients who were selected for ambulatory management, 213 were discharged on the day of their PCI procedure. The reasons for not discharging a patient included a clinically significant puncture site haematoma, angina with transient ECG modifications, and non-cardiovascular reasons (such as transport difficulties). Patients were followed up at one day and 30 days after discharge. Le Corvoisier et al reported that no re-admissions and no major adverse cardiovascular events were reported within the 24 hours after discharge. However, four days after discharge, one patient had a non-fatal myocardial infarction caused by stent thrombosis. A further three patients were readmitted to hospital three, seven, and nine days (respectively) after discharge and were all subsequently discharged within 48 hours after the readmission. Additionally, 87% of patients reported that they were “very satisfied” with ambulatory PCI management. In a cost-analysis, comparing the 220 study patients with 1,820 patients who underwent conventional PCI during the same period, the average total cost for ambulatory PCI was lower than for conventional PCI (€3,120 ± 888 vs. €4,330 ±1,317; p<10-6).
The authors concluded: “Ambulatory PCI in patients with stable coronary artery disease is safe, feasible, and well accepted by the patients. The development of this strategy holds promise for decreasing costs and optimising healthcare resource utilisation by shortening hospital stay.”