Pilot study looks at same-day discharge PCI for acute coronary syndromes
A pilot study recently evaluated the feasibility of same-day discharge (SDD) within six hours of post-percutaneous coronary intervention (PCI) in low-risk, stabilized acute coronary syndrome (ACS) patients in resource-limited settings. Researchers found same-day discharge is feasible for carefully selected, uncomplicated patients.
The study findings were published in the Journal of the Society for Cardiovascular Angiography and Interventions.[1]
Since the early 2000s, SDD after elective PCI has become common at many centers as these procedures have become safer with better stent technology, operator experience and pharmacotherapy. Large PCI registries from several developed countries shown a steady increase in SDD PCI procedures, but use of same-day discharge in PCI for ACS has very limited data. This study aimed to shed more light on the possibility of these programs in areas with limited access to higher levels of care.
The authors said the study sought to evaluate the feasibility of SDD within six hours post-procedure in low-risk, stabilized ACS patients undergoing uncomplicated, noncomplex PCI. From November 2020 to August 2021, 20 consecutive ACS patients, all stable at the time of PCI were included. Inclusion required a complication-free PCI and no clinically significant post procedural events, such as major access site bleeding, hematoma, new or worsening ECG abnormalities, recurrent angina, hemodynamic instability, or stent thrombosis. Patients were also required to have sufficient social support and logistical capacity for timely hospital access in the event of an emergency.
The researchers also selected an additional 80 patients from the data who underwent PCI for ACS during the same period for comparison. They applied the same inclusion and exclusion criteria and performed a 1:4 propensity score matching analysis using variables including age, sex, history of diabetes mellitus, systemic arterial hypertension, dyslipidemia, number of stents implanted, clinical presentation, and culprit artery.
At the seven day follow-up, there were no major adverse cardiovascular events (a composite of death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization) or BARC 3 to 5 bleeding in either group. The median hospitalization duration after PCI was 7.45 ± 1.05 hours in the SDD group, compared with 54.30 ± 164.06 hours in the overnight group, the researchers found.
"This study highlights a markedly different geographic and logistical context compared to prior studies conducted in high-income countries. By situating our findings within this underrepresented healthcare setting, we believe our study contributes meaningful real-world data that may inform clinical practice and health policy in similarly resource-constrained environments," explained Adriano Caixeta, MD, from the division of cardiology at the Paulista School of Medicine, Federal University of São Paulo, and his co-authors in the study.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]