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May 2016

Same-Day Discharge After Percutaneous Coronary Intervention: Current Perspectives and Strategies for Implementation

Author Affiliations
  • 1Department of Medicine, University of Illinois at Chicago
  • 2Division of Cardiology, Department of Medicine, University of Illinois College of Medicine at Peoria
  • 3Division of Interventional Cardiology, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
  • 4Division of Cardiology, St Joseph’s Hospital, Syracuse, New York
  • 5Division of Cardiology, State University of New York Upstate Health Science Center, Syracuse
  • 6Cardiac Catheterization and Electrophysiology Laboratories, Division of Medicine, Palo Alto Veterans Administration Medical Center, Department of Veterans Affairs, Palo Alto, California
  • 7Quebec Heart-Lung Institute, Quebec City, Quebec, Canada
  • 8Department of Cardiology, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
  • 9Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
  • 10Canadian Association of Interventional Cardiology Transradial Interventions Working Group, Ottawa, Ontario, Canada
  • 11The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
  • 12Division of Cardiology, The Commonwealth Medical College, Scranton, Pennsylvania
  • 13Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
JAMA Cardiol. 2016;1(2):216-223. doi:10.1001/jamacardio.2016.0148

Importance  The evolution of percutaneous coronary intervention (PCI) has led to improved safety and efficacy, such that overnight observation can be avoided in some patients. We sought to provide a narrative review of the current literature regarding the outcomes of same-day discharge (SDD) PCI and to describe a framework for the development of an SDD program.

Observations  A literature search of PubMed was performed for human studies on SDD PCI published in English from January 1, 1995, to July 31, 2015. We reviewed the studies between June and September 2015. After literature review, we included reports of randomized clinical trials, observational studies, meta-analyses guidelines, and consensus statements in a narrative review. Compared with overnight observation, there was no increase in adverse events (bleeding, repeat coronary procedures, death, or rehospitalization) among patients in these studies who were discharged on the same day of their PCI procedure. Same-day discharge was associated with significant cost savings and was preferred by patients.

Conclusions and Relevance  The available evidence supports the safety of SDD in selected patients after PCI. Specific programmatic features are important to the successful implementation of SDD after PCI. Greater adoption of SDD programs after PCI has the potential to improve patient satisfaction, increase bed availability, and reduce hospital costs without increasing adverse patient outcomes.