title: 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.
abstract: 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.
  
  
  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 approximately 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725 Chemin Ste Foy, Québec, Canada G1V 4G5. Olivier.Bertrand@crhl.ulaval.ca
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Can Manh
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Bernard
authors.initials: B
authors.lastname: Noël
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
mesh_terms: D000077284:Abciximab; D000368:Aged; D000556:Ambulatory Surgical Procedures; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D017534:Radial Artery; D015607:Stents; D020107:Troponin T / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020107:Troponin T; D000077284:Abciximab