Same-day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society

Taxiarchi, Paraskevi, Kontopantelis, Evangelos, Martin, Glen P., Kinnaird, Tim, Curzen, Nick, Banning, Adrian P., Ludman, Peter, De Belder, Mark, Rashid, Muhammad, Sperrin, Matthew and Mamas, Mamas A. (2019) Same-day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC: Cardiovascular Interventions, 12 (15), 1479-1494. (doi:10.1016/j.jcin.2019.03.030).

Abstract

OBJECTIVES: The aim of this study was to evaluate national temporal trends in same-day discharge (SDD) and compare clinical outcomes with those among patients admitted for overnight stay undergoing elective percutaneous coronary intervention (PCI) for stable angina.

BACKGROUND: Overnight observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from health care systems in which SDD is the predominant practice for elective PCI.

METHODS: Data from 169,623 patients undergoing elective PCI between 2007 and 2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the British Cardiovascular Intervention Society risk model were used to study the association between SDD and 30-day mortality.

RESULTS: The rate of SDD increased from 23.5% in 2007 to 57.2% in 2014, with center SDD median prevalence varying from 17% (interquartile range: 6% to 39%) in 2007 to 66% (interquartile range: 45% to 77%) in 2014. The largest independent association with SDD was observed for radial access (odds ratio: 1.69; 95% confidence interval: 1.65 to 1.74; p < 0.001). An increase in 30-day mortality rate over time for the SDD cases was observed, without exceeding the predicted mortality risk. According to the difference-in-differences analysis, observed 30-day mortality temporal changes did not differ between SDD and overnight stay (odds ratio: 1.15; 95% confidence interval: 0.294 to 4.475; p = 0.884).

CONCLUSIONS: SDD has become the predominant model of care among elective PCI cases in the United Kingdom, in increasingly complex patients. SDD appears to be safe, with 30-day mortality rates in line with those calculated using the national risk prediction score used for public reporting. Changes toward SDD practice have important economic implications for health care systems worldwide.

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Contributors

Author: Nick Curzen

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