Early discharge compared with ordinary discharge after percutaneous coronary intervention – a systematic review and meta-analysis of safety and cost
Authors Abdelnoor M, Andersen JG, Arnesen H, Johansen O
Received 22 September 2016
Accepted for publication 9 January 2017
Published 20 March 2017 Volume 2017:13 Pages 101—109
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Pietro Scicchitano
Michael Abdelnoor,1,2 Jack Gunnar Andersen,3,4 Harald Arnesen,2,5 Odd Johansen6
1Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway; 2Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway; 3Clinic of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; 4Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway; 5Faculty of Medicine, University of Oslo, Oslo Norway; 6Department of Cardiology, Oslo University Hospital, Oslo, Norway
Aim: We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies.
Methods: The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days.
Results: For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52–0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88–1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge.
Conclusion: The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
Keywords: percutaneous coronary intervention, early discharge, cost, meta-analysis
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