Amin Ali Hama, Alqahtani Fahad, Aljohani Sami, Farjo Peter, Patel Kinjan, Kawasra Akram, Guzek Annina, Alkhouli Mohamad
Division of Cardiovascular Disease, West Virginia University, Morgantown, WV, United States of America; Section of Cardiology, Carilion Clinic, Virginia Tech-Carilion School of Medicine, Roanoke, VA, United States of America.
Division of Cardiovascular Disease, West Virginia University, Morgantown, WV, United States of America.
Cardiovasc Revasc Med. 2020 May;21(5):588-591. doi: 10.1016/j.carrev.2019.09.024. Epub 2019 Oct 23.
The safety of same day discharge (SDD) after percutaneous coronary interventions (PCI) has been demonstrated in several studies. However, SDD was only allowed in patients meeting strict criteria. We aimed to evaluate the feasibility and safety of SDD following elective-PCI in all comers.
In 2012, we implemented a strategy of SDD for all elective PCI (no exclusion) but admissions were allowed at the discretion of the treating physician. We assessed the feasibility and safety of this approach in consecutive patients who underwent elective PCI at WVU.
Out of 3355 patients who underwent PCI between 2012 and 2016, 691 (21%) presented electively. Radial access was utilized in 480 (69.5%). Same day discharge was achieved in 539/691 (78%), and there was no difference between patients who had SDD and those who were admitted with regards to the 30-day major adverse cardiovascular and cerebrovascular events (3.2% vs. 3.5% respectively, P = 0.195). Predictors of SDD failure were procedural complications (OR 12.08, 95%CI 2.20-57.8. P = 0.002), use of Glycoprotein IIB-IIIA inhibitors (OR 3.45, 95%CI 1.067-11.41, P = 0.039), femoral access (OR 2.067, 95%CI 1.25-3.419, p = 0.005), anemia (OR 1.80, 95%CI 1.06-3.04, P = 0.029), home distance ≥60 miles (OR 1.68, 95%CI 1.03-2.72, P = 0.037).
SDD is feasible in the majority of all-comers after elective PCI, and is not associated with increase in adverse events at 30-days. Certain procedural and patient's characteristics predict SDD failure. If validated in prospective studies, these factors can possibly be integrated in a predictive tool to aid in triaging patients, post-elective PCI.
多项研究已证实经皮冠状动脉介入治疗（PCI）后当日出院（SDD）的安全性。然而，只有符合严格标准的患者才允许当日出院。我们旨在评估所有患者择期PCI后当日出院的可行性和安全性。
2012年，我们对所有择期PCI患者（无排除标准）实施了当日出院策略，但治疗医生可自行决定是否允许患者住院。我们评估了西弗吉尼亚大学（WVU）连续接受择期PCI患者采用这种方法的可行性和安全性。
在2012年至2016年间接受PCI的3355例患者中，691例（21%）为择期手术。480例（69.5%）采用桡动脉入路。539/691例（78%）实现了当日出院，当日出院患者与住院患者在30天主要不良心血管和脑血管事件方面无差异（分别为3.2%和3.5%，P = 0.195）。当日出院失败的预测因素为手术并发症（比值比[OR]12.08，95%置信区间[CI]2.20 - 57.8，P = 0.002）、使用糖蛋白IIB-IIIA抑制剂（OR 3.45，95%CI 1.067 - 11.41，P = 0.039）、股动脉入路（OR 2.067，95%CI 1.25 - 3.419，P = 0.005）、贫血（OR 1.80，95%CI 1.06 - 3.04，P = 0.029）、家庭距离≥60英里（OR 1.68，95%CI 1.03 - 2.72，P = 0.037）。
择期PCI后，大多数患者当日出院是可行的，且与30天不良事件增加无关。某些手术和患者特征可预测当日出院失败。如果在前瞻性研究中得到验证，这些因素可能会被纳入一个预测工具，以帮助对择期PCI后的患者进行分类。
