Same-day Discharge Following Elective PCI – 10 Year Single Center Experience

Aim: We assessed the feasibility and safety of same-day discharge in an unselected cohort of patients undergoing elective percutaneous coronary intervention (PCI). We also aimed to identify factors predicting failure of same day discharge following elective PCI. Methods: Consecutive patients (n = 1955) undergoing elective PCI between January 2001 and December 2010 were included. Decisions regarding the suitability for same-day discharge were made six hours post procedure. Patient demographics, procedural variables and outcomes were obtained from review of the cardiac catheterisation laboratory database, medical records and a telephone survey. Results: A total of 2619 lesions were treated. The rate of angiographic success was 96.8% and procedural success was achieved in 93.9% of patients. Same day discharge occurred in 1679 (85.8%) patients. The primary reasons for failure to discharge included periprocedural myocardial infarction or ischaemia (26%), use of glycoprotein IIb/IIIa inhibitors (9%), haematomas (11%), late sheath removal (8%) and social reasons (22%). By logistic regression analysis female, age > 80 years old, BMI > 30, hypertension, sheath size ≥7F, femoral access and abciximab use predicted failure of same day discharge whilst use of bivalirudin or an angioseal predicted successful same-day discharge. Only 14 patients (0.7%) experienced complications during the 24 hours following same-day discharge. There were no deaths during this time period. Conclusions: Our study demonstrates that same-day discharge can be achieved safely in a broad range of patients undergoing elective PCI. The use of radial access and smaller sheath sizes, bivalirudin, or an angioseal may facilitate day-case PCI.