Feasibility and safety of same-day discharge after elective transcatheter interventions: experience of a high-volume center

Abstract

Safety of same-day discharge (SSD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD is rarely adopted in Italy, with a potential waste of resources and decrease of patient satisfaction. In 2019 we implemented a strategy of SDD for all elective coronary procedures admitted to our Radial Unit. Patients were excluded from SDD in case of contraindications for radial access, known contrast allergy, known left main disease based on previous angiogram or coronary computed tomography scan, chronic total occlusions considered as target of revascularization. We assessed the feasibility and safety of this approach in consecutive patients treated at Humanitas Research Center. Out of 366 patients who were admitted electively to our Radial Unit, 152 (41.5%) underwent only diagnostic coronary angiography, while 214 underwent PCI. As expected, radial access was used in the vast majority of cases (361; 98.6%). Patients were mostly discharged in the same day (268; 73%), both after diagnostic (96.7%) and interventional (56.5%) procedures. Patients that were hospitalized at least for one night were older, had a higher cardiovascular risk profile and had a more complex coronary anatomy (left main or proximal left anterior descending artery disease, bifurcations, total occlusions). There were no significant differences between patients discharged and those who were admitted overnight with regards to 7- and 30-day hospital readmission. SSD is safe and feasible in the majority of patients after elective coronary procedures (both diagnostic angiography and PCI), and is not associated with increased hospital readmission at 7 and 30 days. On the basis of the current study, a wider SDD program will be implemented in 2020.