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Meta-Analysis
. 2017 Mar 20:13:101-109.
doi: 10.2147/VHRM.S122951. eCollection 2017.

Early discharge compared with ordinary discharge after percutaneous coronary intervention - a systematic review and meta-analysis of safety and cost

Michael Abdelnoor  1 , Jack Gunnar Andersen  2 , Harald Arnesen  3 , Odd Johansen  4
Affiliations
Meta-Analysis

Early discharge compared with ordinary discharge after percutaneous coronary intervention - a systematic review and meta-analysis of safety and cost

Michael Abdelnoor et al. Vasc Health Risk Manag. .

Abstract

Aim: We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies.

Methods: The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days.

Results: For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52-0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88-1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge.

Conclusion: The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.

Keywords: cost; early discharge; meta-analysis; percutaneous coronary intervention.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Details of the search process. Last search was performed August 5, 2015. Abbreviations: RCTs, randomized controlled trials; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Meta-regression for the efficacy of ED compared to OD on the incidence of revascularization versus prevalence of NSTEMI or UAP Notes: The size of the circles is an indicator of the size of the trial. Data adapted from references 4, 13–16, 18, 20, 21, and 23. Abbreviations: ED, early discharge; OD, ordinary discharge; NSTEMI, non-ST elevation myocardial infarction; UAP, unstable angina pectoris; RR, relative risk.
Figure 3
Figure 3
Meta-regression for the efficacy of ED compared to OD on the incidence of revascularization versus prevalence of stable angina pectoris. Notes: The size of the circles is an indicator of the size of the trial. Data adapted from references 4, 13–16, 18, 20, 21, and 23. Abbreviations: ED, early discharge; OD, ordinary discharge; RR, relative risk.
Figure 4
Figure 4
Meta-regression for the efficacy of ED compared to OD on the incidence of rehospitalization versus prevalence of hypertension. Notes: The size of the circles is an indicator of the size of the trial. Data adapted from references 4, 13, 14, and 16–22. Abbreviations: ED, early discharge; OD, ordinary discharge; RR, relative risk.
Figure 5
Figure 5
Meta-regression of the efficacy of ED compared to OD on the incidence of rehospitalization versus prevalence of stable angina pectoris Notes: The size of the circles is an indicator of the size of the trial. Data adapted from references 4 and 13–23. Abbreviations: ED, early discharge; OD, ordinary discharge; RR, relative risk.
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