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Review
. 2024 May;136(Suppl 3):44-60.
doi: 10.1007/s00508-024-02347-z. Epub 2024 May 14.

Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis

Mathias C Brandt  1 , Hannes Alber  2 , Rudolf Berger  3 , Ronald K Binder  4 , Julia Mascherbauer  5 , Alexander Niessner  6 , Martin Schmid  7 , Bernhard Wernly  8 , Matthias Frick  9 ; Austrian working group of interventional cardiology
Affiliations
Review

Same-day discharge after percutaneous coronary procedures-Structured review and comprehensive meta-analysis

Mathias C Brandt et al. Wien Klin Wochenschr. 2024 May.

Abstract

Introduction: Percutaneous coronary intervention is a well-established revascularization strategy for patients with coronary artery disease. The safety and feasibility of performing these procedures on a same-day discharge basis for selected patients has been studied in a large number of mostly nonrandomized trials. An up to date literature review should focus on trials with radial access, representing the current standard for coronary procedures in Austria and other European countries.

Methods: The aim of this consensus statement is to review the most recent evidence for the safety and feasibility of performing same-day discharge procedures in selected patients. A structured literature search was performed using prespecified search criteria, focusing on trials with radial access procedures.

Results: A total of 44 clinical trials and 4 large meta-analyses were retrieved, spanning 21 years of clinical evidence from 2001 to 2022. The outcome data from a wide range of clinical settings were unanimous in showing no negative effect on early (24 h) or late (30 day) major adverse events after same-day discharge coronary procedures. Based on nine prospective trials a comprehensive meta-analysis was compiled. Using 1‑month major adverse events data the pooled odds ratio of same-day discharge versus overnight stay procedures was 0.66 (95% confidence interval, CI 0.35-01.24; p = 0.19; I2 0%), indicating a noninferiority in carefully selected patients.

Conclusion: Outcome data from same-day discharge coronary intervention trials with radial access confirm the robust safety profile showing no increase in the risk of major adverse events compared to overnight stay.

Keywords: Ambulatory coronary intervention; Interventional cardiology; Meta-analysis; Outpatient treatment; Structured review.

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Conflict of interest statement

M.C. Brandt, H. Alber, R. Berger, R.K. Binder, J. Mascherbauer, A. Niessner, M. Schmid, B. Wernly and M. Frick declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing literature search strategy and filtering process for use in meta-analysis. RCT randomized controlled trial, NSTE-ACS non-ST-elevated acute coronary syndrome, TAVI transaortic valve implantation, EP electrophysiology. (adapted from [9])
Fig. 2
Fig. 2
Results of a systematic meta-analysis of prospective trials on the outcome of SDD strategy after PCI. Data show the incidence of MACE at 30 days postprocedure using a Mantel-Haenszel random effects and fixed effects model. (adapted from [9]). a Including all prospective trials (3 randomized and 6 nonrandomized) with a total of 1817 SDD cases, b including only randomized controlled trials with a total population of 979 SDD patients
See this image and copyright information in PMC

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