Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom.
Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom.
JACC Cardiovasc Interv. 2019 Aug 12;12(15):1479-1494. doi: 10.1016/j.jcin.2019.03.030.
The aim of this study was to evaluate national temporal trends in same-day discharge (SDD) and compare clinical outcomes with those among patients admitted for overnight stay undergoing elective percutaneous coronary intervention (PCI) for stable angina.
Overnight observation has been the standard of care following PCI, with no previous national analyses around changes in practice or clinical outcomes from health care systems in which SDD is the predominant practice for elective PCI.
Data from 169,623 patients undergoing elective PCI between 2007 and 2014 were obtained from the British Cardiovascular Intervention Society registry. Multiple logistic regressions and the British Cardiovascular Intervention Society risk model were used to study the association between SDD and 30-day mortality.
The rate of SDD increased from 23.5% in 2007 to 57.2% in 2014, with center SDD median prevalence varying from 17% (interquartile range: 6% to 39%) in 2007 to 66% (interquartile range: 45% to 77%) in 2014. The largest independent association with SDD was observed for radial access (odds ratio: 1.69; 95% confidence interval: 1.65 to 1.74; p < 0.001). An increase in 30-day mortality rate over time for the SDD cases was observed, without exceeding the predicted mortality risk. According to the difference-in-differences analysis, observed 30-day mortality temporal changes did not differ between SDD and overnight stay (odds ratio: 1.15; 95% confidence interval: 0.294 to 4.475; p = 0.884).
SDD has become the predominant model of care among elective PCI cases in the United Kingdom, in increasingly complex patients. SDD appears to be safe, with 30-day mortality rates in line with those calculated using the national risk prediction score used for public reporting. Changes toward SDD practice have important economic implications for health care systems worldwide.
本研究旨在评估全国范围内当日出院（SDD）的时间趋势，并比较稳定型心绞痛患者行择期经皮冠状动脉介入治疗（PCI）时，与接受过夜住院的患者相比，临床结局的差异。
PCI 后常规进行过夜观察，尚无先前的全国性分析表明，在 SDD 已成为择期 PCI 主要治疗模式的医疗体系中，实践或临床结局发生了变化。
从英国心血管介入学会注册处获取了 2007 年至 2014 年间 169623 例行择期 PCI 的患者数据。采用多变量逻辑回归和英国心血管介入学会风险模型研究 SDD 与 30 天死亡率之间的关联。
SDD 率从 2007 年的 23.5%上升至 2014 年的 57.2%，中心 SDD 中位数流行率从 2007 年的 17%（四分位距：6%39%）变化至 2014 年的 66%（四分位距：45%77%）。与 SDD 独立相关的最大因素是桡动脉入路（比值比：1.69；95%置信区间：1.651.74；p<0.001）。SDD 病例 30 天死亡率随时间增加，但未超过预测死亡率风险。根据差异分析，SDD 和过夜住院患者的 30 天死亡率时间变化无差异（比值比：1.15；95%置信区间：0.2944.475；p=0.884）。
SDD 已成为英国择期 PCI 患者的主要治疗模式，且患者病情日益复杂。SDD 似乎是安全的，30 天死亡率与使用全国风险预测评分进行公共报告计算的死亡率相符。SDD 实践的改变对全球医疗体系具有重要的经济意义。
