A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation

Abstract

for the Early Discharge After Transradial Stenting of Coronary Arteries (EASY) Study InvestigatorsBackground-Systematic use of coronary stents and optimized platelet aggregation inhibition has greatly improved the short-term results of percutaneous coronary interventions. Transradial percutaneous coronary interventions have been associated with a low risk of bleeding complications. It is unknown whether moderate-and high-risk patients can be discharged safely the same day after uncomplicated transradial percutaneous coronary interventions. Methods and Results-We randomized 1005 patients after a bolus of abciximab and uncomplicated transradial percutaneous coronary stent implantation either to same-day home discharge and no infusion of abciximab (group 1, nϭ504) or to overnight hospitalization and a standard 12-hour infusion of abciximab (group 2, nϭ501). The primary composite end point of the study was the 30-day incidence of any of the following events: death, myocardial infarction, urgent revascularization, major bleeding, repeat hospitalization, access site complications, and severe thrombocytopenia. The noninferiority of same-day home discharge and bolus of abciximab only compared with overnight hospitalization and abciximab bolus and infusion was evaluated. Two thirds of patients presented with unstable angina and Ϸ20% presented with high-risk acute coronary syndrome prior to the procedure. The incidence of the primary end point was 20.4% in group 1 and 18.2% in group 2 (Pϭ0.017 for noninferiority) with a troponin T-based definition of myocardial infarction; the incidence of the primary end point was 11.1% in group 1 and 9.6% in group 2 (Pϭ0.0004 for noninferiority) with a creatinine kinase myocardial band-based definition of myocardial infarction. No death occurred. Rate of major bleeding in both groups was extremely low at 0.8% and 0.2%, respectively. From 504 patients randomized in group 1, 88% were discharged home the same day. Conclusion-Our data suggest that same-day home discharge after uncomplicated transradial coronary stenting and bolus only of abciximab is not clinically inferior, in a wide spectrum of patients, to the standard overnight hospitalization and a bolus followed by a 12-hour infusion. This novel approach offers a safe strategy for same-day home discharge after uncomplicated coronary intervention. (Circulation. 2006;114:2636-2643.)

Ambulatory transradial percutaneous coronary intervention: A safe, effective, and cost‐saving strategy

“…These results are in agreement with previous studies of PCI using the transradial (9,12) or transfemoral approach (8,10,12). In our population of clinically stable patients referred for PCI, most of the patients were eligible for ambulatory management.…”

“…These changes have called into question the need for an overnight hospital stay after PCI in patients with stable angina. Although several large-scale prospective studies have assessed the feasibility and safety of same-day home discharge after PCI (8)(9)(10)12), additional data collected under the conditions of everyday practice are required before ambulatory PCI can be used on a routine basis.…”

“…In most of the previous studies, many patients were hospitalized before the procedure or transferred from another hospital (9). Similarly, diagnostic coronary angiography was performed before patient inclusion in the study by Heyde et al (10).…”

“…To date, few large-scale prospective studies have evaluated the feasibility and safety of this new patient management strategy (8)(9)(10)(11)(12). In most of these previous studies, patients were discharged on the day of PCI, but many of them were hospitalized at least the day before the procedure for pre-procedure assessment or transferred from another hospital.…”

The Quebec Heart Institute: 50 years of excellence in cardiology

“…It was also the period when young investigators set up a large clinical program in invasive cardiology. In a randomized trial (68), they showed the feasibility and safety of same-day discharge after percutaneous coronary intervention. The investigators are presently leading a multicentre trial on intervention aimed at the regression/stabilization of atherosclerotic plaques.…”