1. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention: results of the Elective PCI in Outpatient Study (EPOS)
- Author
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Marcel G. W. Dijkgraaf, Lea M. Dijksman, Margriet I. Klees, Jan G.P. Tijssen, Robbert J. de Winter, Karel T. Koch, Jan J. Piek, Gerlind S. Heyde, ACS - Amsterdam Cardiovascular Sciences, Cardiology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, APH - Amsterdam Public Health, and Epidemiology and Data Science
- Subjects
medicine.medical_specialty ,Night Care ,Randomization ,medicine.medical_treatment ,Cost-Benefit Analysis ,Coronary Disease ,law.invention ,Randomized controlled trial ,law ,Physiology (medical) ,Angioplasty ,medicine ,Ambulatory Care ,Humans ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Early discharge ,business.industry ,Patient Selection ,Percutaneous coronary intervention ,Health Care Costs ,medicine.disease ,Patient Discharge ,Surgery ,Hospitalization ,Treatment Outcome ,Patient Satisfaction ,Ambulatory ,Conventional PCI ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Percutaneous coronary intervention (PCI) in a day-case setting might reduce logistic constraints on hospital resources, but data on safety are limited. We evaluated the safety and feasibility of same-day discharge after PCI. Methods and Results— Eight hundred consecutive patients scheduled for elective PCI by femoral approach were randomized to same-day discharge or overnight hospital stay. Four hours after PCI, patients were triaged as suitable for early discharge or not. Suitable patients were discharged immediately or kept overnight, according to randomization. Patients with an indication for extended hospital stay were not discharged regardless of randomization. Primary end points were death, myocardial infarction, coronary artery bypass graft surgery, repeat PCI, or puncture-related complications occurring within 24 hours after PCI. A total of 403 patients were assigned to same-day discharge, of whom 77 (19%) were identified for extended observation; 397 patients were assigned to overnight stay, of whom 85 (21%) were identified for extended observation. Among all patients, the composite primary end point occurred in 9 (2.2%) same-day discharge patients and in 17 (4.2%) overnight stay patients (risk difference, −0.020; 95% CI, −0.045 to −0.004; P for noninferiority P for noninferiority Conclusions— Same-day discharge after elective PCI is feasible and safe in the majority (80%) of patients selected for day-case PCI. Same-day discharge does not lead to additional complications compared with overnight stay.
- Published
- 2007