Same-day discharge after elective percutaneous coronary intervention for chronic total occlusion in the UK

Taxiarchi, Paraskevi, Kontopantelis, Evangelos, Kinnaird, Tim, Curzen, Nick, Ahmed, Javed, Zaman, Azfar, Ludman, Peter, Ahmad, Shoaib, Martin, Glen P. and Mamas, Mamas A. (2022) Same-day discharge after elective percutaneous coronary intervention for chronic total occlusion in the UK. Journal of Invasive Cardiology, 34 (3), E179-E189. (doi:10.25270/jic/21.00036).

Abstract

Objectives: this study examines the safety and feasibility of same-day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) to coronary chronic total occlusions (CTOs) and explores independent associations of clinical and procedural characteristics with SDD.

Background: while the recently published consensus statements recommend SDD following uncomplicated CTO-PCI, there are limited studies to support this approach.

Methods: data were obtained from the British Cardiovascular Intervention Society (BCIS) registry dataset including 21,330 patients who underwent CTO-PCI electively from 2007 to 2014 in England and Wales. We used multiple logistic regression to evaluate associations with SDD and the BCIS national risk model to examine for safety of SDD.

Results: although overnight stay remained the standard of care following elective CTO-PCI, SDD practice increased from 21.7% to 44.7%. Women were less likely to have SDD than males. SDD was more common in higher CTO volume centers (36.3%) than low CTO volume centers (31.6%), and SDD patient profiles grew riskier over time, with the average age of SDD patients increasing from 61.4 years to 63.2 years. Transradial PCI was most strongly independently associated with SDD (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.80-2.09). Finally, the SDD observed 30-day mortality rates were not different vs those predicted by the BCIS risk model, and SDD was not independently associated with 30-day mortality (OR, 0.54; 95% CI, 0.25-1.15).

Conclusion: this study illustrates that SDD is safe in selected patients undergoing CTO-PCI.

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Contributors

Author: Nick Curzen

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