Original title: Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention. A Systematic Review and Meta-Analysis Reference: Eltigani Abdelaal et al. J Am Coll Cardiol Intv 2013. Article in press.
Coronary angioplasty and subsequent same day discharge in selected patients can reduce costs and increase patient comfort.
Several observational studies and a few randomized studies have described the safety of same day discharge, however, opinions still vary extensively among the different centers. In an attempt to answer these questions, a meta analysis was carried out to evaluate the total incidence of complications, major cardiovascular events (MACE) and rehospitalization at 30 days.
13 studies were analyzed (5 randomized and 8 observational) with a total of 111830 patients. 96% of procedures were approach by femoral access and 83% of patients were discharged the same day. The median permanence time of same day discharged patients was 4 to 8 hrs.
In randomized studies there were no significant differences in the total number of complications between same day discharged patients and those patients that remained hospitalized (6.5% vs. 5.5% respectively; OR:1.2, 95% IC:0.82 -1.01). At 30 days, MACE incidence in randomized studies was identical in both groups (1.3%), rehospitalizations show no differences as well (4% vs. 3.6%; OR 1.1, 95%IC: 0.7-1.7). Observational studies reached similar conclusions in all the above mentioned.
Conclusion:
The heterogeneous nature of these studies call for a randomized study to assess the correct strategy. Until then, same day discharge after non complicated angioplasty is reasonable in selected patients.
Editorial Comment:
The randomized study that in theory would be necessary to reach a definite valid conclusion should include more than 17,000 patients to reach enough statistic power seeing the low frequency of these events. It is highly unlikely that we will count on this information in a near future, if ever available. Even though the use of the radial artery is less than 5%, if we exclude the analysis of observational studies performed in the USA (Rao et al., among others) the radial approach reaches almost 50% of cases, which speaks for the low preference of this approach in this country. Seeing the main reasons behind same day discharge are cost reduction and patient comfort, the radial approach seems the most sensible choice.
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