title: Safety and efficacy of same-day discharge following elective percutaneous coronary intervention, including evaluation of next day troponin T levels.
abstract: BACKGROUND
  As patients are increasingly undergoing elective percutaneous coronary intervention (PCI) with same-day discharge (SDD), and as post-PCI troponin T (TnT) elevations are associated with increased rates of death/myocardial infarction (MI) following elective PCI, we examined late outcomes with respect to post-PCI TnT elevations in patients undergoing SDD.
  
  
  RESULTS
  We studied 303 patients (mean age 62±9years, 89% male) who underwent elective-PCI between October 2007 and September 2012, of whom 149 had SDD and 154 stayed overnight (ON) who were age-and sex-matched. Eligibility for SDD excluded patients with: multi-vessel PCI, proximal LAD lesions, chronic total occlusions, side branch occlusions, or access site complications. Femoral access rates were 72% and 96% among SDD and ON patients respectively. Post-PCI, SDD patients left at 4.40[4.13-5.30]hours, and ON patients left at 23.44[21.50-25.41]hours (p<0.001). Overall 8.45% met the 2012 universal MI definition. No patients were re-hospitalised within 48hours. At 30-days, unplanned cardiac re-hospitalisation rates were 3.4% and 0.7% among SDD and ON patients (p=0.118); the only event was MI in an SDD patient. At 16[9-32] months, rates of death, MI, target vessel revascularisation, stroke, were 1.3%,1.3%,2.7% and 1% respectively; the composite rate was 6%(6.1% SDD; 6% ON; p=0.965). Late death/MI rates among patients with, and without, post-PCI TnT levels≥5xURL were 3.4% and 2.8% respectively (p=0.588).
  
  
  CONCLUSIONS
  SDD following elective PCI among low risk patients appears to be safe and ≥5 fold post-PCI TnT elevations did not appear to confer incremental short and long term risk. A larger cohort is required to confirm this observation.
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Saad
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Shugman
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Manish
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Iwona
authors.initials: I
authors.lastname: Pauk
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Mussap
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hopkins
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Rajaratnam
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Sidney
authors.initials: S
authors.lastname: Lo
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.affiliation: South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia. Electronic address: j.french@unsw.edu.au.
authors.forename: John K
authors.initials: JK
authors.lastname: French
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D012449:Safety; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T
keywords: Elective percutaneous coronary intervention; Same-day discharge; TroponinT.