Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Eltigani Abdelaal, Sunil V. Rao, Ian Gilchrist, Ivo Bernat, Adhir Shroff, Ronald Caputo, Olivier Costerousse, Samir B. Pancholy, Olivier F. Bertrand

Research output: Contribution to journalReview articlepeer-review

67 Scopus citations

Abstract

Objectives: This study sought to evaluate outcomes of same-day discharge (SDD) following percutaneous coronary intervention (PCI) versus overnight hospitalization (ON). Background: Although there are data on the safety and feasibility of SDD after PCI, ON continues to be prevalent. Methods: The Cochrane search strategy was used to search the PubMed database, EMBASE, and the Cochrane Library for relevant literature. Thirteen studies (5 randomized and 8 observational) of SDD after uncomplicated PCI versus ON met inclusion criteria. 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 rehospitalization within 30 days after PCI. Results: A total of 13 studies, involving 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 to 1.74) in randomized and 0.67 (95% CI: 0.27 to 1.66) in observational studies. Similar results were found for MACE (randomized, OR: 0.99, 95% CI: 0.45 to 2.18; observational, OR: 0.59, 95% CI: 0.06 to 5.57) and rehospitalizations (randomized, OR: 1.10, 95% CI: 0.70 to 1.74; observational, OR: 0.62, 95% CI: 0.10 to 3.98) at 30 days post PCI. Conclusions: There is considerable heterogeneity across published studies comparing SDD with ON. This, coupled with the low event rate and wide corresponding CIs, 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.

Original languageEnglish (US)
Pages (from-to)99-112
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume6
Issue number2
DOIs
StatePublished - Feb 2013

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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