Same day percutaneous coronary intervention discharge: From exception to expectation

Table 1 A milestone-based framework for discharge timing after elective percutaneous coronary intervention

Discharge strategy	Reasonable clinical scenario	Factors favoring this category
Very early discharge (≤ 2-3 hours)	Stable elective PCI with an uncomplicated course	Procedure: Radial/ulnar access, secure hemostasis, no dissection, perforation, no-reflow, or side-branch loss, acceptable contrast load. Patient: No persistent chest pain, ischemic ECG change, arrhythmia, or hemodynamic instability. Program: Confirmed antiplatelet plan, reliable patient understanding, adult support at home, telephone access and a defined rapid re-entry pathway
Extended same-day observation	Moderate-risk patient or procedure with reassuring recovery	Procedure: Selected proximal LAD, uncomplicated multivessel or successful CTO PCI, femoral access with secure closure, longer procedure or higher contrast without instability. Patient: Older age, diabetes, mild-to-moderate CKD, stable recovery. Program: Adequate support with early callback
Overnight observation preferred	High-risk anatomy, complicated procedure, unstable recovery, or inadequate outpatient support	Procedure: Unprotected left main bifurcation, last remaining vessel, atherectomy or lithotripsy, unsuccessful or complicated CTO, periprocedural MI, difficult femoral hemostasis, high contrast with advanced CKD. Patient: Persistent symptoms, ECG changes, arrhythmia, hypotension, bleeding or expanding hematoma. Program: Uncertain antiplatelet adherence, poor health literacy, no transport, caregiver, or rapid access to emergency care

PCI: Percutaneous coronary intervention; ECG: Electrocardiogram; LAD: Left artery descending; CTO: Chronic total occlusion; CKD: Chronic kidney disease; MI: Myocardial infarction.