Same-day Discharge Following Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomised Controlled Trials.

BACKGROUND

Over the past decade, significant advancements in percutaneous coronary intervention (PCI) have substantially reduced periprocedural complications. These developments have also made same-day discharge (SDD) following PCI increasingly feasible. This study aims to provide the most up-to-date evidence on the safety of SDD through a synthesis of randomised controlled trial (RCT) results.

METHODS

We systematically searched the PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases for RCTs comparing the safety of SDD versus overnight stay (ONS) following PCI. Meta-analyses were conducted using a random effects model.

RESULTS

A total of 14 RCTs comprising 3,215 patients (1,608 in the SDD group and 1,607 in the ONS group), primarily with chronic coronary syndrome or low-risk acute coronary syndrome, were included. Our meta-analysis demonstrated that SDD is as safe as ONS, as indicated by the comparable risks of adverse events, including major adverse cardiovascular events (pooled RR 0.76; 95% CI [0.46-1.27]), major bleeding (pooled RR 1.29; 95% CI [0.50-3.37]), vascular complications related to the access site (pooled RR 1.06; 95% CI [0.78-1.45]), rehospitalisation (pooled RR 1.15; 95% CI [0.79-1.68]) and unplanned hospital visits (pooled RR 1.02; 95% CI [0.73-1.42]) within 30 days post-PCI. The results remained robust, regardless of access site, timing of discharge or clinical presentation (all p for interaction >0.05).

CONCLUSION

This up-to-date meta-analysis provides strong evidence supporting the safety of SDD compared with ONS after PCI. Further well-designed RCTs involving high-risk acute coronary syndrome patients are warranted to further clarify the safety of the SDD strategy in this population.