2.1

Study cohort

The Red Cross General Hospital Catheterization Laboratory registry was used in order to retrospectively identify all PCI procedures performed from Second Department of Cardiology during the study period. These procedures were divided into two groups according to the time of their discharge: those that were discharged the same day [same day discharge (SDD) group] and those that had at least one overnight stay [non-same day discharge (non-SDD) group].

The procedures were performed with standard patients care for our hospital. The decision of SDD or not was on operating physician discretion, but in general the following were considered as relative contraindications for this approach: significant procedural complication (prolonged chest pain, no flow or slow flow phenomenon, haemodynamic instability, persistent electrocardiographic changes, major side branch occlusion or suboptimal angiographic result); post procedure electrical or haemodynamic instability; patients with chronic kidney disease with Cr > 1.5 mg/dL and patients with ST elevation myocardial infarction. Patients with non-ST elevation acute coronary syndrome were considered as candidates for SDD in case of at least 48 h uneventful hospital stay before the intervention. Patients with ST elevation myocardial infarction and those with preprocedural serum Cr > 1.5 mg/dL were excluded from the analysis, since they were not considered candidates for SDD.

2.2

Procedural details

Percutaneous coronary intervention was performed via the forearm (radial or ulnar) approach or the femoral approach. Regardless to the type of access in each case, 6 Fr or 7Fr guiding catheters were used to perform angioplasty. Patients that were on dual antiplatelet therapy for at least 5 days received no loading dose, otherwise 325 mg of aspirin and 300 to 600 mg Clopidogrel or 180 mg Ticagrelor or 60 mg Prasougrel were administered orally.

Anticoagulation during the procedure was performed with unfractionated hepatin (100 IU/Kg i.v.) or bivalirudin (0.75 mg/Kgr bolus dose and 1.75 mg/Kgr/h infusion until the end of the procedure) or combination of both. Glycoprotein IIb/IIIa inhibitors were given according to operator’s preference as a bailout treatment.

Procedural success was defined as TIMI-3 post PCI without evidence of dissection or major side branch loss and less than 10% residual stenosis.

2.3

Vascular access management

Hemostasis following forearm approach was achieved with turquinet based closure device (KDL, China), either with traditional patent hemostasis or with the ULTRA method (ulnar artery transient compression to facilitate radial artery patent hemostasis) . In case of transfemoral approach, sheath was removed immediately after the procedure and hemostasis was achieved with closure devices (Angio-Seal, St Jude Medical) or manual compression.

2.4

Post-intervention care

All patients post PCI were monitored in the cardiology department or in the cardiac ICU by specialized staff. Patients who had procedures performed from forearm approach were allowed to mobilize after 30 min their admission to the ward, if this was allowed by their clinical condition. Patients who had PCI through femoral access were ambulated after 4 h of bed rest and another 2 h of uncomplicated observation were necessary before discharge. Instruction about possible future complication related to the procedure, the need for adequate hydration, the medication and the follow up were explained to all patients before discharge.

2.5

Statistical analysis

Data were presented as mean ± SD, median (quartile), or percentage frequency, as appropriate. Differences between groups were established by unpaired t test for normally distributed values and by Mann–Whitney analysis test for nonparametric values. Dichotomized values were compared using the x ² test.

Logistic regression analysis was performed to identify the predictors of the decision of same day discharge. From the baseline table, the variables that were statistically significant between groups were qualified for the further analysis. Statistical analyses were performed with SPSS (version 20.0) statistical package.

2.1

Study cohort

The Red Cross General Hospital Catheterization Laboratory registry was used in order to retrospectively identify all PCI procedures performed from Second Department of Cardiology during the study period. These procedures were divided into two groups according to the time of their discharge: those that were discharged the same day [same day discharge (SDD) group] and those that had at least one overnight stay [non-same day discharge (non-SDD) group].

The procedures were performed with standard patients care for our hospital. The decision of SDD or not was on operating physician discretion, but in general the following were considered as relative contraindications for this approach: significant procedural complication (prolonged chest pain, no flow or slow flow phenomenon, haemodynamic instability, persistent electrocardiographic changes, major side branch occlusion or suboptimal angiographic result); post procedure electrical or haemodynamic instability; patients with chronic kidney disease with Cr > 1.5 mg/dL and patients with ST elevation myocardial infarction. Patients with non-ST elevation acute coronary syndrome were considered as candidates for SDD in case of at least 48 h uneventful hospital stay before the intervention. Patients with ST elevation myocardial infarction and those with preprocedural serum Cr > 1.5 mg/dL were excluded from the analysis, since they were not considered candidates for SDD.

2.2

Procedural details

Percutaneous coronary intervention was performed via the forearm (radial or ulnar) approach or the femoral approach. Regardless to the type of access in each case, 6 Fr or 7Fr guiding catheters were used to perform angioplasty. Patients that were on dual antiplatelet therapy for at least 5 days received no loading dose, otherwise 325 mg of aspirin and 300 to 600 mg Clopidogrel or 180 mg Ticagrelor or 60 mg Prasougrel were administered orally.

Anticoagulation during the procedure was performed with unfractionated hepatin (100 IU/Kg i.v.) or bivalirudin (0.75 mg/Kgr bolus dose and 1.75 mg/Kgr/h infusion until the end of the procedure) or combination of both. Glycoprotein IIb/IIIa inhibitors were given according to operator’s preference as a bailout treatment.

Procedural success was defined as TIMI-3 post PCI without evidence of dissection or major side branch loss and less than 10% residual stenosis.

2.3

Vascular access management

Hemostasis following forearm approach was achieved with turquinet based closure device (KDL, China), either with traditional patent hemostasis or with the ULTRA method (ulnar artery transient compression to facilitate radial artery patent hemostasis) . In case of transfemoral approach, sheath was removed immediately after the procedure and hemostasis was achieved with closure devices (Angio-Seal, St Jude Medical) or manual compression.

2.4

Post-intervention care

All patients post PCI were monitored in the cardiology department or in the cardiac ICU by specialized staff. Patients who had procedures performed from forearm approach were allowed to mobilize after 30 min their admission to the ward, if this was allowed by their clinical condition. Patients who had PCI through femoral access were ambulated after 4 h of bed rest and another 2 h of uncomplicated observation were necessary before discharge. Instruction about possible future complication related to the procedure, the need for adequate hydration, the medication and the follow up were explained to all patients before discharge.

2.5

Statistical analysis

Data were presented as mean ± SD, median (quartile), or percentage frequency, as appropriate. Differences between groups were established by unpaired t test for normally distributed values and by Mann–Whitney analysis test for nonparametric values. Dichotomized values were compared using the x ² test.

Logistic regression analysis was performed to identify the predictors of the decision of same day discharge. From the baseline table, the variables that were statistically significant between groups were qualified for the further analysis. Statistical analyses were performed with SPSS (version 20.0) statistical package.