Long term outcome of elective day case percutaneous coronary intervention in patients with stable angina.
van Gaal WJ., Arnold JR., Porto I., Jennings B., Ashar V., Schrale RG., Banning AP.
Patients undergoing elective PCI are traditionally admitted overnight, however day case PCI cuts costs and has been proposed as a safe method for selected patients. We evaluated the success and long term clinical outcomes of day case percutaneous coronary intervention (PCI) for outpatients with stable angina. In total, 484 consecutive patients treated over a five year period with planned day case PCI were studied and followed up for 12 months. Successful PCI with same day discharge was performed in 463 patients (95.7%). There were 21 patients (4.3%) who required hospital admission. Reasons for failed discharge were hematoma formation (n=7, 1.4%), coronary dissection (n=4, 0.8%), post-procedural chest pain (n=3, 0.6%), prolonged procedure (n=2, 0.4%), and 1 each of acute stent thrombosis, coronary perforation, anaphylaxis, minor drug reaction and a functional study for untreated disease. One year follow up was complete for 439/484 (90.7%). At 12 months there were 6 hospitalizations for angina (1.2%, 95% CI 0.6-3.0%), 20 repeat revascularisations (4.1%, 95% CI 2.7-6.3%), 3 myocardial infarctions (0.6%, 95% CI 0.2-2.1%) and 2 deaths (0.4%, 95% CI 0.1-1.6%). Event free survival at 1 year follow up was 93.6% (95% CI 90.7-95.6%). Selecting patients for day case PCI is safe, and can achieve a high rate of success with excellent long term outcomes.