Author + information
- Olivier F. Bertrand,
- Eltigani Abdelaal,
- Sunil V. Rao,
- Ian C. Gilchrist,
- Ivo Bernat,
- Adhir Shroff,
- Ronald Caputo,
- Olivier Costerousse and
- Samir Pancholy
Although there is data on the safety and feasibility of same-day discharge (SDD) after percutaneous coronary intervention (PCI), overnight hospitalization (ON) continues to be prevalent. No systematic reviews that have comprehensively examined this subject currently exist. This study aimed to evaluate outcomes of SDD following PCI vs. ON.
The Cochrane search strategy was used to search PubMed database, EMBASE and the Cochrane Library. Abstracts from international cardiology meeting programs were searched for relevant data. In addition, journal article bibliographies were hand searched. There was no date or language restriction Randomized trials (N=5) and observational studies (N=8) comparing SDD with ON after uncomplicated PCI were analyzed. The data were pooled using a random effects model, and reported as odds ratios (OR) with their 95% confidence intervals (CI). The primary outcomes were incidence of total complications, major adverse cardiovascular events (MACE), and re-hospitalization within 30 days after PCI.
Data from the 13 studies, involving a total of 111,830 patients were pooled. There was significant variation in the definition of outcomes across studies. For total complications, the strategy of SDD compared with ON after PCI had an estimated OR of 1.20 (95% CI: 0.82-1.74) in randomized and 0.67 (95%CI: 0.27-1.66) in observational studies. Similar results were found for MACE (randomized: OR 0.99, 95%CI: 0.45-2.18; observational: OR 0.59, 95%CI: 0.06-5.57) and re-hospitalizations (randomized: OR 1.10, 95%CI: 0.70-1.74, observational: OR 0.62, 95%CI: 0.10-3.98) at 30-days post PCI.
There is considerable heterogeneity across published studies comparing SDD with ON. This, coupled with low event rate and wide corresponding confidence intervals, suggest that an adequately powered multicenter randomized trial comparing SDD with ON would require a very large sample size (>17,000). Until such a trial is completed, SDD after uncomplicated PCI seems a reasonable approach in selected patients.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Tests, Targets and Treatments in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1240-66
- 2013 American College of Cardiology Foundation