Same-day discharge coronary interventions: How to succeed?

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Percutaneous coronary interventions (PCI) are the cornerstone of treatment in patients with coronary artery disease, generating substantial costs for the healthcare system. Considerable improvements in PCI technique, stent technology, and antiplatelet therapy led to a complication rate of <5%, a success rate of >95%, and lack of routine cardiothoracic surgical support. Thereby, the concept of same-day discharge following PCI has been proposed due to comparable efficacy, safety, and socioeconomic benefits of inpatient PCI. Although single-vessel disease was the primary indication for outpatient (OP) PCI, more complex scenarios such as multivessel disease, left main disease, and chronic total occlusions were also shown to be feasible and safe in the OP setting. Currently, available data show that OP PCI leads to cost optimization, increased capacity of PCI centers, decrease in the nosocomial infections rate, and increased patient satisfaction, along with good clinical outcomes. Although OP PCI seems promising in a subset of well-prepared and compliant patients without severe comorbidities, there are some challenges to overcome before its routine implementation. To prevent unnecessary hospitalization and unsafe same-day discharges, interventional cardiology teams should be trained to perform reliable risk-benefit assessments. Standardized forms should be created to obtain informed consent and instruct OP PCI patients and their relatives about postprocedural management. Here, we summarize the available data on OP and inpatient PCI outcomes, discuss the opportunities and challenges of OP PCI, and propose a periprocedural patient management checklist to facilitate the implementation of OP PCI in interventional cardiology centers.