Overnight observation after elective percutaneous coronary intervention (PCI) may not be necessary for selected low-risk patients, according to a new study.

Researchers at the Duke Clinical Research Institute (DCRI; Durham, NC, USA) conducted a multicenter cohort study based on data from 107,018 patients 65 years or older undergoing elective PCI procedures to evaluate the prevalence and outcomes of same-day discharge between November 2004 and December 2008. The study involved 903 sites participating in the CathPCI Registry, with patients linked with US Medicare Part A claims. The main outcome measures were death or rehospitalization occurring within two days and by 30 days after PCI.

The results showed that the prevalence of same-day discharge was 1.25%, with significant variation across facilities. Patient characteristics were similar between the two groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. There were no significant differences in the rates of death or rehospitalization at two days (circa 0.5%) compared to overnight stay, or at 30 days (at 9.7%). Among patients with adverse outcomes, the median time to death or rehospitalization did not differ significantly between the groups. After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization. The study was published in the October 5, 2011, issue of the Journal of the American Medical Association (JAMA).

“With the current economic state, it is important to look for areas in the healthcare system where major cost-savings can be found and implemented, while also keeping the safety of the individual patient a top priority,” said lead author Sunil Rao, MD. “A center that's thinking about doing same-day discharge has to have a protocol in place and a set of instructions for the patients so that it can be done safely.”

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