Same-day discharge safe after chronic total occlusion PCI for select patients
Key takeaways:
- The rate of same-day discharge after chronic total occlusion PCI rose from 3% to 21% between 2015 and 2021.
- Radial-only access was most strongly associated with same-day discharge.
Registry data show same-day discharge after PCI cases for chronic total occlusion is safe in select patients, has been increasing over time and is strongly associated with radial‐only access, researchers reported.
“For selected patients, same-day discharge after a PCI and even a CTO PCI is safe,” Paul B. Poommipanit, MD, FACC, FSCAI, director of the Coronary Chronic Total Occlusion Program at Harrington Heart & Vascular Institute, University Hospitals, told Healio. “There are many qualifying factors that go into same-day discharge after PCI and CTO PCI specifically. Successful revascularization is the first one. Successful hemostasis is another one. The ability to have someone at home to observe the patient and procedure completion in a timely fashion is also important. Follow-up protocols after same-day discharge are also important. All patients in our large health care system are contacted the following day to ensure they are doing OK and received all of their medications.”
Data were derived from Simsek B, et al. Catheter Cardiovasc Interv. 2023;doi:10.1002/ccd.30644.
Poommipanit and colleagues compared clinical, angiographic and in‐hospital procedural outcomes of same-day discharge vs. overnight observation among 7,181 participants in the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) registry.
Within the cohort, 13% of patients had same-day discharge after CTO PCI.
The same-day discharge rate increased from 3% in 2015 to 21% in 2022. Those who were discharged on the same day were less likely to have a history of HF (21% vs. 26%; P = .005), chronic lung disease (10% vs. 15%; P = .001) or anemia (12% vs. 19%; P < .001).
Technical success was similar between groups (same-day discharge, 87% vs. overnight observation, 88%; P = .289); however, the incidence of in‐hospital MACE was lower among patients who were discharged on the same day compared with patients kept for overnight observation (0 vs. 0.4%; P = .041).
In a multivariable logistic regression analysis, prior MI (OR = 0.71; 95% CI, 0.59-0.87; P = .001), chronic lung disease (OR = 0.64; 95% CI, 0.47-0.88; P = .006) and increasing procedure time (OR per 10‐minute increase = 0.93; 95% CI, 0.91-0.95; P < .001) were associated with overnight observation. In addition, radial‐only access was strongly associated with same-day discharge (OR = 2.45; 95% CI, 2.03-2.96; P < .001), the researchers wrote.
Among registry participants who were discharged on the same day, two were readmitted, one for retroperitoneal bleeding and one for ischemic stroke, according to the researchers.
The researchers noted that the finding that radial‐only access had the strongest association with same-day discharge could be due to a preprocedural goal by operators to discharge the patient the same day, leading to a preference for radial‐only access, which allows earlier mobility. “Clinical implications of this and other studies are already being seen with the progression of same-day discharge overseas and in the U.S.,” Poommipanit told Healio. “The development of ambulatory surgical centers for PCI are occurring throughout the U.S. Further research to define the parameters to qualify for same-day discharge is an important step going forward.”
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