Radial access key to same-day success
An accompanying editorial by Deepak Bhatt, MD, and Jonathan G. Sung, MBChB, who are both interventional cardiologists at Brigham and Women’s Hospital, Boston, generally agreed with the premise that these data support judicious use of same-day discharge for elective PCI.
They pointed out limitations in the study, including its retrospective design and the inability to look at important outcomes other than mortality and 30-day rehospitalization, such as bleeding, that are relevant to the safety of early discharge, but concluded that same-day discharge, as well as radial access procedures, are underused.
“For uncomplicated elective PCI, we should aim for same-day discharge,” Dr. Bhatt said in an interview. He linked this to radial access.
“Radial access certainly facilitates same-day discharge, though even beyond that aspect, it should be the default route of vascular access whenever possible,” Dr. Bhatt said. Yet he was careful to say that neither same-day discharge nor radial access can be recommended in all patients. While the operator needs “to be comfortable” with a radial access approach, there are multiple factors that might preclude early discharge.
“Of course, if a long procedure, high contrast use, bleeding, a long travel distance to get home, etc. [are considered], then an overnight stay may be warranted,” he said.
Dr. Bradley advised centers planning to increase their same-day discharge rates for elective PCI to use a systematic approach.
“Sites should identify areas for opportunity in the use of same-day discharge and then track the implications on patient outcomes to ensure that the approach being used maintains high-quality care,” he said.
Dr. Bradley reported no potential conflicts of interest. Dr. Bhatt has received research funding from a large number of pharmaceutical and device manufacturers, including those that make products relevant to PCI.