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Same-day discharge may be safe after PCI for non-ST-elevation ACS

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WASHINGTON — Same-day discharge after PCI for non-ST-elevation ACS is not associated with adverse outcomes after 30 days, researchers reported at the American College of Cardiology Scientific Session.

“The majority of patients stay overnight for observation post-PCI, but with the adoption of the transradial approach, same-day discharge is now feasible,” Ibrahim Kassas, MD, from the University of Massachusetts Medical School, said during a presentation.

Ibrahim Kassas

The researchers conducted a single-center, retrospective study of patients who underwent PCI for non-ST-elevation ACS, which included unstable angina and non-STEMI, at a high-volume transradial center from 2011 to 2014. Hospital readmission, bleeding and all-cause mortality were assessed at 30 days.

Kassas and colleagues including Mohammed Akhter, MD, interventional cardiologist and principal investigator of this study, noted that their institution was unique, as an early adopter of PCI via transradial access starting in 2009. In the past year, 91% of STEMI and 85% of non-ST elevation ACS cases were performed using the radial access.

The institution had therefore adopted a protocol for early discharge. Same-day discharge was considered for patients who had successful, uncomplicated PCI. These patients were monitored in a recovery unit for 4 to 6 hours after the procedure. If they experienced chest pain, ECG and cardiac biomarkers were obtained, and the decision for early discharge was made at the discretion of the attending physician.

Of the 2,273 patients included in the analysis, 23% were discharged on the same day, 52% were monitored overnight and discharged the next day, and 25% required extended admission.

Fewer women were in the same-day discharge group than in the next-day discharge group (19.4% vs. 28.5%; P = .003), and the percentage of patients with prior PCI was higher in the same-day discharge group than in the next-day discharge group (44% vs. 33.5%; P < .001), Kassas noted.

Eighty-four percent of patients in the same-day discharge group presented initially with unstable angina, whereas only 16% presented with non-STEMI. In contrast, 51% of patients in the next-day discharge group presented with non-STEMI and 49% presented with unstable angina. Additionally, radial access was used in 93% of patients who were discharged the same day vs. 83% in those who were discharged the next day (P < .001).

Patients were also risk-stratified using TIMI risk score, Global Registry of Acute Coronary Events (GRACE) score, Gensini score for CAD severity and ACC/American Heart Association classification for lesion complexity. According to the study results, the GRACE score was higher in the next-day discharge group compared with the same-day discharge group (111 vs. 105; P = .01), but no significant associations were noted for the other scores.

Thirty-day outcomes showed that patients discharged the same day had lower readmission rates than those discharged the next day (7.3% vs. 10.9%; P = .03). Rates of all-cause mortality and bleeding at 30 days, however, were not significantly different between the same-day discharge and next-day discharge groups.

In a subgroup analysis of 30-day outcomes, patients with unstable angina had higher readmission rates after next-day discharge vs. same-day discharge (11.9% vs. 6.7%; P = .03), but this difference was not seen in patients with non-STEMI.

“With risk stratification, same-day discharge after PCI for non-ST-elevation ACS appears to be safe, at least compared with next-day discharge, and use of GRACE score could optimize patient selection for same-day discharge,” Kassas said. – by Melissa Foster

Reference:

Kassas I, Akhter M, et al. Abstract 903-12. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Disclosure: Kassas and Akhter report no relevant financial disclosures.

Editor’s Note: On March 31, 2017, this article was updated with additional information about the same-day PCI protocol, courtesy of the researchers.