Author + information
- Received June 7, 2012
- Revision received September 26, 2012
- Accepted October 26, 2012
- Published online February 1, 2013.
- Eltigani Abdelaal, MD⁎,
- Sunil V. Rao, MD†,
- Ian C. Gilchrist, MD‡,
- Ivo Bernat, MD§,
- Adhir Shroff, MD, MPH∥,
- Ronald Caputo, MD¶,
- Olivier Costerousse, PhD⁎,
- Samir B. Pancholy, MD# and
- Olivier F. Bertrand, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Olivier F. Bertrand, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy. Québec, Québec, G1V4G5, Canada
Objectives This study sought to evaluate outcomes of same-day discharge (SDD) following percutaneous coronary intervention (PCI) versus overnight hospitalization (ON).
Background Although there are data on the safety and feasibility of SDD after PCI, ON continues to be prevalent.
Methods The Cochrane search strategy was used to search the PubMed database, EMBASE, and the Cochrane Library for relevant literature. Thirteen studies (5 randomized and 8 observational) of SDD after uncomplicated PCI versus ON met inclusion criteria. Data were pooled using a random effects model, and reported as odds ratios (OR) with their 95% confidence intervals (CI). The primary outcomes were incidence of total complications, major adverse cardiovascular events (MACE), and rehospitalization within 30 days after PCI.
Results A total of 13 studies, involving 111,830 patients were pooled. There was significant variation in the definition of outcomes across studies. For total complications, the strategy of SDD compared with ON after PCI had an estimated OR of 1.20 (95% CI: 0.82 to 1.74) in randomized and 0.67 (95% CI: 0.27 to 1.66) in observational studies. Similar results were found for MACE (randomized, OR: 0.99, 95% CI: 0.45 to 2.18; observational, OR: 0.59, 95% CI: 0.06 to 5.57) and rehospitalizations (randomized, OR: 1.10, 95% CI: 0.70 to 1.74; observational, OR: 0.62, 95% CI: 0.10 to 3.98) at 30 days post PCI.
Conclusions There is considerable heterogeneity across published studies comparing SDD with ON. This, coupled with the low event rate and wide corresponding CIs, suggest that an adequately powered multicenter randomized trial comparing SDD with ON would require a very large sample size (>17,000). Until such a trial is completed, SDD after uncomplicated PCI seems a reasonable approach in selected patients.
Dr. Abdelaal is supported by the Laval University Transradial Research and Education Fund. Dr. Bertrand is a research-scholar of the Quebec Foundation for Health Research. Dr. Rao has received honoraria as a consultant for Terumo Medical and The Medicines Company. Dr. Shroff has received honoraria from Cordis, Terumo Medical, and The Medicines Company. Dr. Caputo has received honoraria as a consultant for Boston Scientific, Medtronic, and Terumo. Dr. Pancholy has received speaker honoraria from The Medicines Company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 7, 2012.
- Revision received September 26, 2012.
- Accepted October 26, 2012.
- American College of Cardiology Foundation