Abstract 2835: Same-Day Discharge can be Achieved Safely in the Majority of Patients Undergoing Percutaneous Coronary Intervention for High Risk Lesions
Introduction: The majority of day-case percutaneous coronary intervention (PCI) programs exclude patients with high risk lesions. We investigated whether day-case PCI can safely be expanded to include patients with high risk lesions.
Methods: The study included 1096 consecutive patients undergoing elective PCI between January 2001 and April 2006. We evaluated the outcomes of patients with at least one high risk lesion defined as either a lesion in a saphenous vein graft (SVG), an unprotected left main stem (LMS), a type C lesion or a bifurcation lesion where the side branch was at least 2mm in diameter. The remaining patients formed the control group. All patients were reviewed by a cardiologist six hours post procedure and discharged if there was no evidence of complications and social circumstances were adequate.
Results: There were 695 control and 401 high risk patients with 914 and 587 lesions respectively. Patients in the high risk group were more likely to be male, hypertensive and have had previous myocardial infarction, PCI or coronary artery bypass grafting (all P<0.05). The high risk group comprised of 100 patients with a bifurcation, 3 with unprotected LMS, 51 with SVG and 248 with other type C lesions. The in-hospital and short term outcomes are shown in table 1⇓. Although high risk patients were less likely to have successful outcomes, same day discharge was achieved in 82% of these patients with a low risk of readmission within 24 hours. There were no deaths but one case of stent thrombosis occurred in each of the groups within 24 hours of discharge.
Conclusion: Patients undergoing elective PCI to high risk lesions can safely be discharged on the same day if there are no in-hospital complications. Lower rates of procedural success and higher rates of MACE are consistent with the more complex nature of these interventions.