Blog | Wednesday, May 8, 2013

QD: News Every Day--PCI may be safe as an outpatient procedure

Same-day discharge had a low rate of major complications and may be as safe as routine overnight observation in patients undergoing elective percutaneous coronary intervention (PCI), a meta-analysis concluded

Researchers collated data from 12,803 patients in 37 studies, of which there were 7 randomized controlled trials of 2,738 patients and 30 observational studies of 10,065 patients. The majority of patients in both cohorts underwent the procedure for stable angina.

Results appeared online in the Journal of the American College of Cardiology.

In the randomized trials, there was no difference between same-day discharge and routine overnight observation with regard to death, myocardial infarction or target lesion revascularization (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.43 to 1.87; P=0.78) or for major bleeding/vascular complications (OR, 1.69; 95% CI, 0.84 to 3.40; P=0.15).

In observational studies, death, myocardial infarction and target lesion revascularization occurred at a pooled rate of 1.00% (95% CI, 0.58% to 1.68%), and major bleeding or vascular complications occurred at a pooled rate of 0.68% (95% CI, 0.35% to 1.32%).

Same-day discharge has been considered for 15 years, but never adopted due to safety concerns, the researchers noted. Also, there have been doubts about patient acceptance, although this study noted that many individual trials found high rates of patient satisfaction. But the trials used different tools to collect the data and couldn't be analyzed collectively.

And, hospitals are reimbursed for elective PCI at the outpatient rate regardless of whether the patient stays for more than 23 hours, so facilities could potentially generate savings.

Researchers cautioned that the trials and cohorts considered low-risk patients and allowed overnight triage when needed, as well as short-term follow-up with patients who were successfully discharged. "Centers planning to implement a same-day discharge program should develop formal criteria for identification of appropriate patients as well as a system for close follow-up," they wrote.