Published Online
on December 4, 2006

A more recent version of this article appeared on December 12, 2006

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Submitted on May 11, 2006
Revised on September 18, 2006
Accepted on September 22, 2006

A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation

Olivier F. Bertrand MD, PhD^*, Robert De Larochellière MD, Josep Rodés-Cabau MD, Guy Proulx MD, Onil Gleeton MD, Can Manh Nguyen MD, Jean-Pierre Déry MD, MSc, Gérald Barbeau MD, Bernard Noël MD, Éric Larose DVM, MD, Paul Poirier MD, PhD, Louis Roy MD, for the Early Discharge After Transradial Stenting of Coronary Arteries (EASY) Study Investigators

From the Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l’Université Laval, Québec, Canada.

^* To whom correspondence should be addressed. E-mail: Olivier.Bertrand{at}crhl.ulaval.ca.

Background--Systematic use of coronary stents and optimized platelet aggregation inhibition has greatly improved the short-term results of percutaneous coronary interventions. Transradial percutaneous coronary interventions have been associated with a low risk of bleeding complications. It is unknown whether moderate- and high-risk patients can be discharged safely the same day after uncomplicated transradial percutaneous coronary interventions.

Methods and Results--We randomized 1005 patients after a bolus of abciximab and uncomplicated transradial percutaneous coronary stent implantation either to same-day home discharge and no infusion of abciximab (group 1, n=504) or to overnight hospitalization and a standard 12-hour infusion of abciximab (group 2, n=501). The primary composite end point of the study was the 30-day incidence of any of the following events: death, myocardial infarction, urgent revascularization, major bleeding, repeat hospitalization, access site complications, and severe thrombocytopenia. The noninferiority of same-day home discharge and bolus of abciximab only compared with overnight hospitalization and abciximab bolus and infusion was evaluated. Two thirds of patients presented with unstable angina and 20% presented with high-risk acute coronary syndrome prior to the procedure. The incidence of the primary end point was 20.4% in group 1 and 18.2% in group 2 (P=0.017 for noninferiority) with a troponin T-based definition of myocardial infarction; the incidence of the primary end point was 11.1% in group 1 and 9.6% in group 2 (P=0.0004 for noninferiority) with a creatinine kinase myocardial band-based definition of myocardial infarction. No death occurred. Rate of major bleeding in both groups was extremely low at 0.8% and 0.2%, respectively. From 504 patients randomized in group 1, 88% were discharged home the same day.

Conclusion--Our data suggest that same-day home discharge after uncomplicated transradial coronary stenting and bolus only of abciximab is not clinically inferior, in a wide spectrum of patients, to the standard overnight hospitalization and a bolus followed by a 12-hour infusion. This novel approach offers a safe strategy for same-day home discharge after uncomplicated coronary intervention.

Key words: angioplasty • coronary disease • platelets • stents • trials • transradial

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