Abstract 2834: Time to Adverse Events in REPLACE-2: Implications for Same-Day Discharge of PCI Patients
Background: Although patients undergoing percutaneous coronary intervention (PCI) in the United States typically have overnight stays, several pilot studies suggest that many patients may be discharged safely on the same day. We hypothesized that most complications in a contemporary PCI trial, REPLACE-2, would not be missed by a same-day discharge strategy (after 8 hours observation).
Methods: We analyzed percentage of major complications occurring within and after 8 hours in patients enrolled in REPLACE-2. We performed a multivariate logistic regression to determine predictors of complications after 8 hours (missed by early discharge). Finally, we analyzed percentage of major complications in “ideal same-day discharge” patients (no unstable angina or recent myocardial infarction, procedure time <90th percentile, no intraprocedural dissection).
Results: In the entire REPLACE-2 cohort, 6.3% (371/5903) had death, myocardial infarction, or urgent revascularization within 8 hours. From 8–24 hours, 0.3% had death, myocardial infarction, or urgent revascularization (D/M/R), and 0.1% died. Predictors of increased D/M/R from 8 to 24 hours included duration of procedure, dissection with decreased flow, lack of thienopyridine pretreatment, or lack of thienopyridine treatment after procedure. Among “ideal” patients, D/M/R occurred in 4.7% patients within 8 hours (135/2879) and in 0.1% patients from 8 to 24 hours. In ideal patients 1 out of 2879 died within 8 hours (0.03%), and 1 patient died from 8 to 24 hours.
Conclusion: In REPLACE-2, the great majority of ischemic complications occurred within 8 hours of PCI, suggesting that most patients can be discharged safely after 8 hours. Given the economic implications of this strategy for PCI patients, a large, prospective trial is warranted.