Study Of Costs Realized After Percutaneous Coronary intervenTion Employing Same Day Discharge

This is a prospective randomized clinical trial of same day discharge versus overnight stay
for patients undergoing uncomplicated elective or low-risk urgent PCI with uncomplicated
post-PCI recovery. The outcome is total cost accrued by patients from the time of index
hospital presentation through 30-day post-PCI follow-up.

Conduct of PCI procedures and provision of post-PCI care will be in accordance with routine
institutional practices and will not be protocol-driven.

Consented patients will be assigned to SDD or ON stay using a block randomization schedule.
Randomization will occur once the patient has completed an uncomplicated 6-hour post PCI
observation period.

Inclusion Criteria:

- Consecutive patients who undergo elective or low-risk, (i.e., in the setting of
unstable angina but not non-ST segment elevation myocardial infarction) urgent PCI.

- No sociodemographic factors that would preclude SDD (prohibitive factors include no
family member/friend available to remain with patient until nurse phone call the
following day, no working phone, no reliable transportation, home > 60 minutes from
medical infrastructure, unable to obtain/pay for medications).

- PCI procedures performed between 08/04/14 and 08/03/16.

- Short term risk of in-hospital death, transfusion or contrast-induced nephropathy
during the index hospitalization at or below 1% using Blue Cross Blue Shield of
Michigan Cardiovascular Consortium (BMC2) PCI registry risk prediction models.

- No in-lab complications (prolonged angina, acute closure, no reflow, significant or
untreated dissection, vessel perforation, side branch occlusion, rescue glycoprotein
IIb/IIIa inhibitor use, ventricular tachycardia or fibrillation requiring
cardioversion/defibrillation, tamponade, pulmonary edema, stroke or transient ischemic
attack, shock).

- Contrast Volume/Calculated Creatinine Clearance ratio < 3

- No recurrent chest pain, shortness of breath, hemodynamic instability, bleeding or
vascular complications during 6 hours in recovery area post-PCI

Exclusion Criteria:

- Use of rotational atherectomy

- Use of a glycoprotein IIb/IIIa inhibitor infusion post-PCI