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Patients undergoing elective Percutaneous Coronary Interventions (PCI) are generally observed overnight in the hospitals, mainly because of the fear of the PCI related complications. Prevalence of same day discharge after elective PCI is still very low in the United States (1.5% as quoted in recent studies), with variation across the facilities and the operators.
Information from a pre-existing quality assurance database was deidentified and used in this retrospective review. All patients undergoing elective PCI between a 2 year period at a single center with five different operators were selected. Information regarding clinical characteristics, co-morbidities, anatomic & procedural details, immediate complications, re-hospitalization and mortality within 30 days was collected.
372 patients had elective PCI, 95 (25.5%) were discharged the same day. Among the radial group, 78 (36.6%) out of 213 patients and femoral 17(10.8%) of the 157 patients were discharged the same day. One of the operators discharged 82% (37/45) of his elective patients the same day. 30% of the patients had age >70 years, 15% had GFR <60 and 2% had GFR <30, 24% had LVEF <60 and 2.1% had LVEF <30. None of them had immediate procedural complications. Overall, there were no deaths at 30 days and four patients were hospitalized. Post procedure day 3 sub acute stent thrombosis due to clopidogrel non compliance, day 9 with radial artery pseudoaneurysm, and day 28 with chest pains, none of which could have been prevented by overnight hospital stay.
Same day discharge after elective PCI at our institution was significantly higher than the national average and had operator variability. There was no mortality, post procedural complications or repeat hospitalizations within 30 days that could have been prevented with overnight observation. Simple success or failure of the procedure without intraprocedural complications seems to be the important distinguishing feature of a PCI that can define who can safely be discharged.