Adoption of same day discharge following elective left main stem percutaneous coronary intervention

Abstract

Background This study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. Methods We analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. Results SDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30–1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17–1.41) and those requiring ON stay (OR 0.58 95%CI 0.25–1.34). Conclusions We did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.

Clinical outcomes of patients undergoing elective percutaneous coronary intervention with same-day discharge. Ten-year follow-up

“…Even with the in creased anatomical and clinical complexity of PCIs in current practice (chronic coronary occlusion, left main coronary artery obstruction, multivessel disease), hospital discharge on the same day remains a feasible and safe strategy in most scenarios. 10,11 In our series, we noticed an increase in complexity of cases, demonstrated by an higher percentage of diabetic patients (28% versus 42%), greater number of bifurcation lesions (5% versus 15%), greater use of drug-eluting stents, and an increase in type B2 and C lesions (28% versus 46%), as shown in figure 2. These changes were not associated with an increase in adverse events.…”

Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

“…Patients with prognosis‐modifying lesions such as significant LM stenosis were more likely to undergo PCI instead of delayed CABG or no intervention at all. Delays in the safe reintroduction of cardiac surgery services due to insufficient COVID‐19 testing capacity, lack of bed availability and the resurgence in COVID‐19 case numbers, were likely to play a role in decision‐making regarding revascularisation strategy, with a shift towards LM PCI, which is associated with shorter length of stay and even a same day discharge, 26 to avoid further growth in CABG waiting lists. This is certainly in keeping with European Society of Cardiology guidance during the COVID‐19, which recommended Heart Team discussions on hybrid revascularisation (PCI and CABG) or full PCI for patients whose interventions cannot be postponed 27 .…”

Changing the model of care during the COVID-19 pandemic: Same-day discharge of patients undergoing elective invasive cardiac procedures in Hong Kong

“…In addition, acute stent thrombosis remains a nightmare of PCI, which is a great concern of cardiologists when considering the time to discharge patients. 8 Altogether, these factors incur additional risks to PCI patients, which may explain why they were less likely to be discharged on the same day. For IVUS, it is the most common imaging modality adopted in our center to guide the decision of stent deployment, particularly for those borderline and complex lesions involving left main artery.…”

“…Patients with complex PCI, left main artery involvement, two-stent bifurcation, complete total occlusion and atherectomy currently are not considered candidates for SDD in our center. We note that evidence supporting the safety of SDD for these high-risk patients is accumulating rapidly, 8 and these exclusion criteria may be lifted in the near future. We further found that the patient's age was not a significant predictor of SDD.…”

“…Three meta-analyses consistently demonstrated the safety of SDD for patients after uncomplicated PCI. 4 , 5 , 6 Recent studies have examined the safety profile of SDD among patients with complex lesions, 7 , 8 and the evidence to date has not indicated an additional risk associated with SDD relative to an overnight hospital stay. Moreover, SDD is associated with higher patient satisfaction and lower costs incurred by both patients and healthcare systems.…”