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Chang WC, Chien YC, Tsai CT, Huang WC, Huang WC, Lin GM. Letter to the Editor: Risk-stratified observation windows in outpatient percutaneous coronary intervention. World J Cardiol 2026; 18(11): 127774 [DOI: 10.4330/wjc.127774]
Wei-Cheng Chang, Yu-Ching Chien, Department of Medicine, Tri-Service General Hospital Songshan Branch, Taipei 105, Taiwan
Chun-Tsai Tsai, Wei-Chieh Huang, Cardiovascular Center, Taipei Veterans General Hospital, Taipei 112, Taiwan
Wei-Chun Huang, Department of Internal Medicine, Pingtung Christian Hospital, Pingtung County 90059, Taiwan
Gen-Min Lin, Department of Medicine, Hualien Armed Forces General Hospital, Hualien 970, Taiwan
Author contributions: Chang WC and Lin GM conceptualized the commentary and formulated the study design; Chien YC, Tsai CT, Huang WC, and Huang WC performed the literature review and synthesis; Chang WC, Chien YC, and Lin GM drafted the manuscript; Tsai CT and Huang WC contributed to critical intellectual revisions; and all authors gave final approval of the version to be published.
AI contribution statement: During the preparation of this work, the author(s) used Google Gemini Pro for grammar checking and copy editing. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.
Supported by Hualien Armed Forces General Hospital, No. HAFGF-D-115004.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Gen-Min Lin, Director, FACC, FAHA, FESC, Department of Medicine, Hualien Armed Forces General Hospital, No. 163 Jiahua St., Xincheng Township, Hualien 970, Taiwan. farmer507@yahoo.com.tw
Received: September 7, 2026 Revised: October 22, 2026 Accepted: November 5, 2026 Published online: November 26, 2026 Processing time: 70 Days and 16.1 Hours
Abstract
For outpatient or same-day discharge after an uncomplicated elective percutaneous coronary intervention, consensus statements and society guidance frequently utilize a pragmatic post-procedure observation window of 4 hours to 6 hours in uncomplicated patients. Although clinical trials and registries show that acute ischemic and vascular complications predominantly cluster within the initial 2 hours to 6 hours or after 24 hours, significant clinical heterogeneity and varying hemostasis protocols exist across real-world practice. In the work published in the World Journal of Cardiology, Klocek et al reported a substantial cohort of 444 patients who underwent a total of 787 percutaneous coronary intervention procedures and were discharged after a median observation window of 150 minutes (ranging from 65 minutes to 523 minutes), suggesting that ultra-short observation may be feasible in selected settings. In this correspondence, we emphasize three key priorities to optimize clinical applicability: (1) Establishing a standardized operational definition of the observation interval (e.g., from sheath removal, hemostasis achievement, or recovery arrival); (2) Delineating institutional pre- and post-procedure discharge-selection criteria; and (3) Reporting granular, risk-stratified patient and procedural profiles across discrete monitoring windows alongside minor access-site complications and patient-reported outcomes.
Core Tip: Same-day discharge after percutaneous coronary intervention commonly relies on a 4-6-hour observation window in uncomplicated elective cohorts, though optimal timing varies according to baseline risk, vascular access, and hemostasis strategy. Recent findings by Klocek et al suggest the feasibility of an ultra-short median observation of 150 minutes. To translate these provocative real-world findings into generalizable clinical practice, we prioritize establishing the operational definition of the observation duration, detailing the discharge-selection criteria, and analyzing risk-stratified outcomes across discrete observation cohorts (< 4 hours, 4-6 hours, and > 6 hours).
