Chapter 23: Same-Day Discharge After Successful PCI

Percutaneous Coronary Intervention (PCI) is the most commonly performed cardiac intervention in contemporary practice, with over 50% of all procedures performed in the United States. With rising costs of healthcare delivery, same-day discharge (SDD) in selected patients after PCI may lead to reduced costs, while increasing patients’ satisfaction without compromising clinical safety and efficacy.

Trends in PCI Outcomes

Following PCI, clinicians and patients are often concerned about both the ischemic risk due to stent thrombosis and MI, in addition to periprocedural bleeding risk, vascular complications, and the need for readmission. On the other hand, healthcare managers are concerned about unnecessary inpatient stays with associated increased costs and logistic constraints, costs due to procedural complications, and avoidable readmissions.

Historically, therefore, patients were kept overnight (ON) post POBA for fear of abrupt vessel closure, or stent thrombosis with associated morbidity and mortality, and need for scrutiny of access site complications (often transfemoral access – TFA). In contemporary practice, however, the ischemic risk is negligible, and risk of vascular complications is consistently lower with TRA compared with transfemoral access (TFA).

Author: 
Eltigani Abdelaal, MD, MRCP and Olivier Bertrand, MD, PhD