At present, percutaneous coronary intervention (PCI) is the most common coronary revascularization strategy. One of its benefits is that patients can be safely discharged when procedures are programed, which helps decompress hospital capacity.
However, this strategy has not been validated for acute coronary syndromes; the evidence gathered for non-ST elevation ACS is far from robust, and therefore is not recommended by guidelines.
It might be validated for low risk NSTE-ACS.
1385 NSTE-ACS cases treated with non-elective PCI were analyzed. 300 of these cases (19.6%) were discharged on the same day (SDD) and 1085 the following day (NDD).
Primary end point was readmission for any cause at 30 days.
SDD patients were evaluated within 4-6 hours after procedure. If there were no complications, they were considered for discharge.
Mean age was 62, there were no differences in hypertension, diabetes, COPD, dialysis, peripheral vascular disease or CABG. TIMI and GRACE scores were similar. 11% received IIb IIIa inhibitors.
The SDD group showed lower increase of biomarkers and anemia. The use of the transradial approach was more frequent and anatomy was less complex in this group.
The presence of unstable angina was higher in patients receiving SDD and NSTE-ACS in those receiving NDD.
There was no difference in stent use, treated artery, number of treated vessels or the use of IVUS.
In the SDD group discharge was seen more often during the morning (vs. the other cohort, more often discharged during the afternoon).
Read also: High Risk of Bleeding after PCI: More Evidence for Short DAPT.
Hospital stay was 8 hours in the SDD cohort and 26 in the NDD group.
Primary end point was more frequent in the NDD group (OR = 1.6 [1.01-2.57]; P < 0.01)
There were no differences in mortality and bleeding at 30 days and one year.
Factors associated with SDD were: male sex, transradial approach, negative biomarkers and time of procedure.
After propensity score matching, there were no differences in readmissions and mortality at 30 days.
Conclusion
SDD after non-elective PCI for NSTE-ACS might be a valid alternative to NDD in selected low risk patients, seeing as it was comparable in mortality, bleeding and readmission rate.
Original Title: Same day discharge following non-elective PCI for non-ST elevation acute coronary syndromes.
Reference: Essa Hariri, et al. Am Heart J 2022;246:125–135.
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