Same-day discharge after PCI for NSTE-ACS is on the rise

“It’s pretty much become standard to discharge patients the same day as their procedure in patients who have elective PCI for stable angina,” Rao, a professor with the NYU Grossman School of Medicine, told Cardiovascular Business during an interview at TCT 2025. He noted that advances in PCI safety, including an increased use of intracoronary imaging and the widespread adoption of radial access, prompted interest in whether similar discharge patterns were emerging in higher-risk populations. 

Rao hoped to learn more about same-day discharge after PCI for NSTE-ACS patients. The registry analysis captured multiple discharge scenarios, including patients who presented through the emergency department and went home the same day, as well as those admitted for one or more days who were discharged on the same day as their PCI. The CathPCI Registry only includes in-hospital outcomes.

Overall, complication rates were extremely low. And while same-day discharge after PCI for NSTE-ACS remained uncommon, the data showed a clear upward trend over time.

"What we saw was that there was an increasing trend over time of patients with acute coronary syndrome going home the same day as their PCI procedure. Perhaps not surprisingly, we saw an inflection point right around the time of COVID. After COVID, the rates kept going up,” Rao said. "I think it's because ... when people who were doing this realized that it was safe, it kind of became ingrained in the process of how they were actually seeing and discharging patients."

Geographic differences were modest, but hospital-level variation was substantial. 

“Depending on which hospital a patient was seen at, there may be a doubling in the chances of going home the same day,” Rao said, highlighting the role of local protocols and institutional culture.

Rao emphasized that the findings are descriptive rather than prescriptive.

“Now, whether it’s safe or not is a separate question. We need to do more research to see if it’s safe, but it does seem to be an increasing trend,” he said. “These are selected patients. We don’t advocate for this as a widespread strategy, but it’ll be interesting to see how this pans out over the next few years.”

Rao also stressed patient selection, noting that many same-day discharge patients likely had low-level troponin elevations and low ischemic risk, along with stable access sites without bleeding complications. This may have been facilitated by wider use of radial access PCI.

The analysis also raises questions about future reimbursement models and value-based care, although cost data were not available in the registry.

“Unfortunately, the registry doesn’t have costs, but I have to imagine that a same-day discharge strategy would in fact be cost saving for the hospital,” Rao said.

For now, he cautioned that overnight observation remains the standard of care for most acute coronary syndrome patients, even as real-world practice continues to evolve.