Outcomes of Same-Day Discharge in Chronic Total Occlusion Percutaneous Coronary Intervention.

BACKGROUND . Same-day discharge (SDD) following percutaneous coronary intervention (PCI) is increasingly used, yet data on its safety after chronic total occlusion PCI (CTO PCI) remain limited.

OBJECTIVES . We retrospectively analyzed all CTO PCI procedures performed at a single U.S. center between 2019-2023, comparing patients discharged the same day with those who were not.

METHODS . The primary endpoint was 30-day major adverse cardiac and cerebrovascular events (MACCE) or rehospitalization. Analyses included multivariable Cox proportional hazards regression and recursive partitioning.

RESULTS . Among 1,273 patients, 352 (27.6%) underwent SDD. SDD patients had lower comorbidity burden (Charlson Comorbidity Index [CCI] 3.6±3.1 vs 4.2±2.8, p=0.002), and better renal function (eGFR 78.6±24.2 vs 73.7±23.3 mL/min/1.73 m², p=0.001). In-hospital MACCE occurred in 0% of SDD vs 2.0% of non-SDD patients (p<0.001). At 30 days, MACCE/rehospitalization was significantly lower in the SDD group (4.3% vs 7.9%, p=0.021). Multivariable analysis identified body mass index (adjusted hazard ratio [aHR] 1.09; 95% confidence interval [CI] 1.02-1.16; p=0.010), CCI (aHR 2.16; 95% CI 1.37-4.49; p=0.003), and antegrade dissection/re-entry use (aHR 1.86; 95% CI 1.09-3.34; p=0.040) as independent correlates of 30-day adverse events, while SDD itself was not. A recursive partitioning model identified CCI, eGFR, and distance to the PCI center (driving miles) as the strongest discriminators of risk within the SDD cohort.

CONCLUSION . In this large contemporary series, SDD after CTO PCI was safe and feasible in carefully selected patients. Comorbidity burden, renal function, procedural complexity, and patient geography may help guide SDD decision-making in modern CTO practice.