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Same Day Discharge After Elective Percutaneous Coronary Intervention

Abstract

Same-day percutaneous coronary intervention (PCI) is a reality with modern interventional equipment and pharmaceutical agents. Elective PCI is rarely an inpatient procedure and is now predominantly considered an outpatient procedure. Approaches to safely manage elective patients through same-day PCI have been well described in the literature and demonstrate no safety signal compared with overnight monitoring in the elective patient. With the costs of elective PCI being time dependent in comparison to fixed reimbursement of outpatient care, the efficiencies to bed utilization offered by same-day PCI make this attractive from an efficiency view point. Patient satisfaction improves with same-day discharge. The potential for cost-efficient care can only be maximized if health care providers view this shift to outpatient PCI care as an impetus to improve the whole care process rather than an administrative change with no effect on actual patient care. Same-day PCI is effective and can be integrated into modern health care.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Bottner RK, Blankenship JC, Klein LW, et al. Current usage and attitudes among interventional cardiologists regarding the performance of Percutaneous Coronary Intervention (PCI) in the outpatient setting. Catheter Cardiovasc Interv. 2005;66:455–61.

    PubMed  Article  Google Scholar 

  2. 2.

    Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994;331:489–95.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Hearn JA, King III SB, Douglas Jr JS, et al. Clinical and angiographic outcomes after coronary artery stenting for acute or threatened closure after percutaneous transluminal coronary angioplasty. Initial results with a balloon-expandable, stainless steel design. Circulation. 1993;88:2086–96.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Schömig A, Neumann F-J, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med. 1996;334:1084–9.

    PubMed  Article  Google Scholar 

  5. 5.

    Chew DP, Bhatt DL, Lincoff AM, et al. Defining the optimal activated clotting time during percutaneous coronary intervention: aggregate results from 6 randomized, controlled trials. Circulation. 2001;103:961–6.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Tolleson TR, O’Shea JC, Bittl JA, et al. Relationship between heparin anticoagulation and clinical outcomes in coronary stent intervention: observations from the ESPRIT trial. J Am Coll Cardiol. 2003;41:386–93.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Lincoff AM, Bittl JA, Harrington RA, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA. 2003;289:853–63.

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Marso SP, Amin AP, House JA, et al. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA. 2010;303:2156–64.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Kiemeneij F, Laarman GJ, Odekerken D, Slagboom T, van der Wieken R. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the ACCESS study. J Am Coll Cardiol. 1997;29:1269–75.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Kern MJ. Cardiac catheterization on the road less traveled: navigating the radial vs femoral debate. JACC Cardiovasc Interv. 2009;2:1055–6.

    PubMed  Article  Google Scholar 

  11. 11.

    Kiemeneij F, Laarman GJ, Slagboom T, Stella P. Transradial Palmaz-Schatz coronary stenting on an outpatient basis: results of a prospective pilot study. J Invasive Cardiol. 1995;7:5A–11.

    PubMed  Google Scholar 

  12. 12.

    Kiemeneij F, Laarman GJ, Slagboom T, van der Wieken R. Outpatient coronary stent implantation. J Am Coll Cardiol. 1997;29:323–7.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Slagboom T, Kiemeneij F, Laarman GJ, van der Wieken R, Oderkerken D. Actual outpatient PTCA: the results of the OUTCLAS pilot study. Catheter Cardiovasc Interv. 2001;53:204–8.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Slagboom T, Kiemeneij F, Laarman GJ, Van der Wieken R. Outpatient coronary angioplasty; feasible and safe. Catheter Cardiovasc Interv. 2005;64:421–7.

    PubMed  Article  Google Scholar 

  15. 15.•

    Feldman D, Swaminathan R, Kaltenbach L, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the NCDR (2007–2012). Circulation. 2013;127:2295–306. Most recent look at transradial growth in the United States using data from the NCDR.

  16. 16.•

    Subherwal S, Peterson ED, Dai D, et al. Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: a report from the National Cardiovascular Data CathPCI Registry. J Am Coll Cardiol. 2012;59:1861–9. NCDR based analysis of bleeding with PCI and factors associated with bleeding.

  17. 17.•

    Abdelaal E, Rao SV, Gilchrist IC, et al. Same-day discharge compared with overnight hospitalization after uncomplicated percutaneous coronary intervention: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2013;6:99–112. Recent meta-analysis of same-day discharge compared with overnight admission including both radial and femoral approaches showing no evidence for harm, but statistically unable to prove non-inferiority due to low event rates.

  18. 18.

    Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ. Same-day discharge after percutaneous coronary intervention: a meta-analysis. J Am Coll Cardiol. 2013;62:275–85.

    PubMed  Article  Google Scholar 

  19. 19.

    Wilentz JR, Mishkel G, McDermott D, et al. Outpatient coronary stenting using the femoral approach with vascular sealing. J Invasive Cardiol. 1999;11:709–17.

    CAS  PubMed  Google Scholar 

  20. 20.

    Gilchrist IC, Nickolaus MJ, Momplaisir T. Same-day transradial outpatient stenting with a 6-hr course of glycoprotein llb/llla receptor blockade: a feasibility study. Catheter Cardiovasc Interv. 2002;56:10–3.

    PubMed  Article  Google Scholar 

  21. 21.

    The Medicare Recovery Audit Contractor (RAC) Program: an evaluation of the 3-year demonstration. 2008;2. (http://www.cms.gov/RAC/Downloads/RAC%20Evaluation%20Report.pdf).

  22. 22.

    Resnic FS. The case for outpatient coronary intervention: balancing charges and discharges. Circulation. 2007;115:2248–50.

    PubMed  Article  Google Scholar 

  23. 23.

    Chambers CE, Dehmer GJ, Cox DA, et al. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv. 2009;73:847–58.

    PubMed  Article  Google Scholar 

  24. 24.

    Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 6, §20.6; and Medicare Claims Processing Manual, CMS Pub. 100-04, Chapter 4, §290.1.

  25. 25.

    FY 2014 Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) final rule (CMS-1599-F). http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2014-IPPS-Final-Rule-Home-Page.html. Accessed 15 Oct 2013.

  26. 26.•

    Gilchrist IC, Rhodes DA, Zimmerman HE. A single center experience with same-day transradial-PCI patients: a contrast with published guidelines. Catheter Cardiovasc Interv. 2012;79:583–7. Review of 100 patient co-incidental with release of SCAI guidelines for same-day suggesting guidelines are too restrictive.

  27. 27.

    Ziakas A, Klinke P, Mildenberger R, et al. Safety of same day discharge radial PCI in patients under and over 75 years of age. Int Heart J. 2007;48:569–78.

    PubMed  Article  Google Scholar 

  28. 28.

    Ranchord AM, Prasad S, Seneviratne SK, et al. Same-day discharge is feasible and safe in the majority of elderly patients undergoing elective percutaneous coronary intervention. J Invasive Cardiol. 2010;22:301–5.

    PubMed  Google Scholar 

  29. 29.

    Bagur R, Bertrand OF, Rodés-Cabau J, et al. Comparison of outcomes in patients 70 years versus <70 years after transradial coronary stenting with maximal antiplatelet therapy for acute coronary syndrome. Am J Cardiol. 2009;104:624–9.

    PubMed  Article  Google Scholar 

  30. 30.

    Banning AP, Ormerod OJM, Channon K, et al. Same day discharge following elective percutaneous coronary intervention in patients with stable angina. Heart. 2003;89:665–6.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  31. 31.

    Bertrand OF, De Larochellière R, Rodés-Cabau J, et al. Early Discharge After Transradial Stenting of Coronary Arteries Study Investigators. 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. Circulation. 2006;114:2636–43.

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Hodkinson EC, Ramsewak A, Murphy JC, et al. An audit of outcomes after same-day discharge post-PCI in acute coronary syndrome and elective patients. J Interv Cardiol. 2013. doi:10.1111/joic.12065.

    PubMed  Google Scholar 

  33. 33.

    Small A, Klinke P, Della Siega A, et al. Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study. Catheter Cardiovasc Interv. 2007;70:907–12.

    PubMed  Article  Google Scholar 

  34. 34.

    Bertrand OF, Rodés-Cabau J, Larose E, et al. Early and late outcomes in patients excluded from same-day home discharge after transradial stenting and maximal antiplatelet therapy. Catheter Cardiovasc Interv. 2008;72:619–25.

    PubMed  Article  Google Scholar 

  35. 35.

    Fefer P, Daoulah A, Strauss BH, et al. Visible angiographic complications predict short and long-term outcomes in patients with post-procedural creatine-phosphokinase elevation. Catheter Cardiovasc Interv. 2010;76:960–6.

    PubMed  Article  Google Scholar 

  36. 36.

    Hauck K, Zhao X. How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients. Med Care. 2011;49:1068–75.

    PubMed  Article  Google Scholar 

  37. 37.

    Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. J Am Coll Cardiol. 2011;58:e44–122.

    PubMed  Article  Google Scholar 

  38. 38.

    Gleeton G, Noel B, Larose E, Poirier P, Roy L. 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. Circulation. 2006;114:2636–43.

    PubMed  Article  Google Scholar 

  39. 39.

    Bagur R, Bertrand OF, Rodés-Cabau J, et al. Long term efficacy of abciximab bolus-only compared to abciximab bolus and infusion after transradial coronary stenting. Catheter Cardiovasc Interv. 2009;74:1010–6.

    PubMed  Article  Google Scholar 

  40. 40.•

    Verheugt FW, Steinhubl SR, Hamon M, et al. Incidence, prognostic impact, and influence of antithrombotic therapy on access and nonaccess site bleeding in percutaneous coronary intervention. JACC Cardiovasc Interv. 2011;4:191–7. Analysis of trial data showing the hazards of both access site and nonaccess site bleeding along with the choice of anti-thrombotic therapy on outcomes.

  41. 41.•

    Mamas MA, Ratib K, Routledge H, et al. Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention: are the results of randomized trials achievable in clinical practice? J Am Coll Cardiol Intv. 2013;6:698–706. Analysis from the British Cardiovascular Society database showing the improved outcomes in PCI from transradial use as market penetration passes the 50 % mark for radial access in the United Kingdom.

  42. 42.•

    Tarvis DR, Wang Y, Jacobs S, et al. Bleeding and vascular complications at the femoral access site following percutaneous coronary intervention (PCI): an evaluation of hemostasis strategies. J Invasive Cardiol. 2012;24:328–34. Recent analysis of transfemoral complications with the use of newer hemostasis strategies that show improved outcomes over time.

  43. 43.•

    Baklanov DV, Kim S, Marso SP, Subherwal S, Rao SV. Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry. Circ Cardiovasc Interv. 2013;6:347–53. NCDR based analysis showing cumulative benefit from shift to bivalirudin and also shift to radial from femoral in an additive fashion.

  44. 44.

    Ziakas AA, Klinke BP, Mildenberger CR, et al. Safety of same-day discharge radial percutaneous coronary intervention: a retrospective study. Am Heart J. 2003;146:699–704.

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Porto I, Blackman DJ, Nicolson D, et al. What is the incidence of myocardial necrosis in elective patients discharged on the same day following percutaneous coronary intervention? Heart. 2004;90:1489–90.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  46. 46.

    Lauck S, Johnson JL, Ratner PA. Self-care behaviour and factors associated with patient outcomes following same-day discharge percutaneous coronary intervention. Eur J Cardiovasc Nurs. 2009;8:190–9.

    PubMed  Article  Google Scholar 

  47. 47.•

    Rao SV, Kaltenbach LA, Weintraub WS, et al. Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients. JAMA. 2011;306:1461–7. NCDR based analysis of PCI procedures in the US showing present same-day procedures in the United States and outcomes vs overnight admission.

  48. 48.

    Rinfret S, Kennedy WA, Lachaine J, et al. Economic impact of same-day home discharge after uncomplicated transradial percutaneous coronary intervention and bolus-only abciximab regimen. JACC Cardiovasc Interv. 2010;3:1011–9.

    PubMed  Article  Google Scholar 

  49. 49.

    Le Corvoisier P, Gellen B, Lesault PF, et al. Ambulatory transradial percutaneous coronary intervention: a safe, effective, and cost-saving strategy. Catheter Cardiovasc Interv. 2013;81:15–23.

    PubMed  Article  Google Scholar 

  50. 50.

    Brewster S, Khimdas K, Cleary N, et al. Impact of a dedicated “radial lounge” for percutaneous coronary procedures on same-day discharge rates and bed utilization. Am Heart J. 2013;165:299–302.

    PubMed  Article  Google Scholar 

  51. 51.

    Amin AP, House JA, Safley DM, et al. Costs of transradial percutaneous coronary intervention. JACC Cardiovasc Interv. 2013;6:827–34.

    PubMed  Article  Google Scholar 

  52. 52.

    Declercq E, Simmes D. The politics of “drive-through deliveries”: putting early postpartum discharge on the legislative agenda. Milbank Q. 1997;75:175–202.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  53. 53.

    Gilchrist IC. There is no place like home after successful PCI. Catheter Cardiovasc Interv. 2009;74:1017–8.

    PubMed  Article  Google Scholar 

  54. 54.

    Knopf WD, Cohen-Bernstein C, Ryan J, et al. Outpatient PTCA with same day discharge is safe and produces high patient satisfaction level. J Invasive Cardiol. 1999;11:290–5.

    CAS  PubMed  Google Scholar 

  55. 55.

    Ziakas A, Klinke P, Fretz E, et al. Same-day discharge is preferred by the majority of the patients undergoing radial PCI. J Invasive Cardiol. 2004;16:562–5.

    PubMed  Google Scholar 

  56. 56.

    Perret X, Bergerot C, Rioufol G, Bonvini RF, Ovize M, Finet G. Same-day-discharge ad hoc percutaneous coronary intervention: initial single-center experience. Arch Cardiovasc Dis. 2009;102:743–8.

    PubMed  Article  Google Scholar 

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Conflict of Interest

Ian C. Gilchrist has received consulting fees from The Medicines Company, Inc., Accumed, Inc., and Abbott Vascular, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Ian C. Gilchrist.

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This article is part of the Topical Collection on Interventional Cardiology

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Gilchrist, I.C. Same Day Discharge After Elective Percutaneous Coronary Intervention. Curr Cardiol Rep 16, 470 (2014). https://doi.org/10.1007/s11886-014-0470-y

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Keywords

  • Cardiac catheterization
  • Radial artery
  • Femoral artery
  • Outcomes
  • Percutaneous coronary intervention (PCI)
  • Complications
  • Outcome
  • Economics
  • Patient satisfaction
  • Bleeding
  • History
  • Coronary artery disease
  • Disease management
  • Outpatient care
  • Inpatient care
  • Nursing care
  • Social support
  • Closure device
  • Cardiac stent
  • Bivalirudin
  • Heparin
  • Cost-effectiveness
  • Same day discharge