Growing evidence and evolving practice patterns are reshaping postprocedure care for patients undergoing percutaneous coronary intervention (PCI). 

Once considered standard to observe overnight, many patients are now safely discharged the same day — a trend driven by advances in procedural technique, patient-satisfaction goals, and cost pressures.

Srihari Naidu, MD, professor of medicine at New York Medical College and director of the cardiac catheterization laboratory at Westchester Medical Center in Valhalla, New York, said that for carefully selected elective cases, many patients will experience better outcomes when they are able to recover in their own familiar surroundings, and that the evidence base and procedural controls support sending many patients home the same day.

Naidu, the current president of the Society for Cardiovascular Angiography and Interventions, first developed same-day discharge protocols about a decade ago.

“If patients had good family support, they didn’t live that far away from the hospital, we could figure that they’d be reasonable in terms of understanding whether there’s any problem with bleeding and those kinds of things and be reliable to come back in, and they’d take their medications, plus they didn’t have a lot of medical problems that would make them higher risk for a problem,” Naidu said.

Naidu said that technical factors relating to the patient’s procedure itself also have a bearing on which patients qualify for same-day discharge.

“We needed to make sure they didn’t have a very complicated procedure — that’s something that is a technical determination based on where the blockage was. Was it very difficult? Was it more than one stand? Did it take a long time? What kind of blood thinners did we need? All these aspects,” he said. “If they didn’t have any of those things, we would watch them for 4-6 hours and send them home, understanding that the complication rate is low.”

Roy Ziegelstein, MD, cardiologist and editor-in-chief at DynaMed, said the shift reflects both opportunity and necessity.

“The major drivers are cost, patient satisfaction, and bed availability,” he said. “Many patients can be safely discharged the same day after several hours of observation — especially those in good health with strong caregiver support at home and an uncomplicated procedure.”

Why It Matters: Transition-of-Care Risks Shift Outward

As more cardiac procedures move to outpatient settings, the early-risk window moves with them. Without overnight observation, complications that once surfaced under hospital supervision may now arise at home, in primary care offices, or back in the emergency department.

“Vascular injury and bleeding remain the main concerns once a patient leaves the hospital,” Ziegelstein said. “Because cardiac procedures require vascular access, those are the complications clinicians still need to be mindful of. Others include rhythm disturbances, myocardial injury, or, rarely, allergic reactions to contrast dye or medications.”

Naidu agreed that even when outcomes are excellent, vigilance must continue. 

“These same-day patients don’t stop being ‘postprocedure’ just because they’re not in a bed,” he said. “We’ve effectively shifted the recovery phase into the outpatient environment, which means communication has to be tighter than ever.”

The Evidence Base

Multiple registries and meta-analyses confirm that same-day discharge PCI is safe for properly selected patients, with no excess in major adverse cardiac events, bleeding, or readmissions compared with overnight stays. The Heart Rhythm Society and the American College of Cardiology issued a scientific statement in April endorsing same-day discharge after intracardiac catheter ablation, provided institutions have clear screening criteria, reliable hemostasis protocols, and contingency plans for late complications.

“These decisions are individualized,” Ziegelstein said. “We look at age, comorbidities, caregiver support, patient preference, procedural complexity, and whether there were any immediate complications. Even the time of day matters — if observation ends late, it may not be safe or desirable for the patient to go home.”

What remains largely untested, both experts noted, is whether existing transitional-care models — built for inpatients — fit these outpatient procedures. 

What Primary Care Physicians and Hospitalists Need to Watch

Before discharge, primary care physicians (PCPs) and hospitalists should make sure they are looped in on procedural planning and discharge discussions. Knowing which patients are eligible for same-day discharge — and on what criteria — helps outpatient teams anticipate who might need closer monitoring, Naidu said. 

“It’s not enough to assume the cardiology note will cover everything. The primary care clinician should know exactly what was done, what medications changed, and what to watch for over the next 24 hours,” Naidu said. He advised requesting a concise risk summary that includes bleeding risk, renal function, and access site, along with any other factors that could influence postprocedure follow-up.

Naidu said that for caregivers, a clear and complete summary at the time of discharge is essential. It should list all medication changes with the reasoning behind them, note any pending results, and specify when and whom the patient and/or the caregiver should call for questions or to report concerning symptoms.

Both cardiologists emphasized the importance of clarifying for the caregiver and the patient who will track late results and who assumes responsibility for urgent issues. 

“When it’s unclear who owns that first 24-hour window, that’s when things fall apart,” Naidu said.

In the first 24-48 hours, proactive outreach can make the difference between a smooth recovery and an emergency department visit. A quick phone or telehealth check-in from the nursing staff, care navigation, or other personnel on the care team can help identify symptoms, including chest pain, shortness of breath, palpitations, dizziness, swelling, or bleeding, that might otherwise go unnoticed. Laboratory checks, such as hemoglobin and creatinine, when contrast load or medication changes warrant it, can also catch early problems.

“Even though we’re sending them home, the recovery still belongs to us collectively,” Naidu said. “That communication in the first day or two is what keeps same-day discharge safe.”

Red-Flag Symptoms and Escalation

Naidu outlined a handful of symptoms that should trigger the patient to call for immediate help. 

“If they’re short of breath, fainting, or having any chest pain that reminds them of their preprocedure symptoms, that’s an ambulance call,” he said. “Minor bruising or mild oozing — call your doctor. Anything that could be cardiac or major bleeding shouldn’t wait.”

Naidu said that awareness extends to the surgical site. He said that many of these procedures are now performed with an access point at the wrist and that going through the radial artery reduces the bleeding risk over an entrance via the femoral artery. Thus, procedures performed radially are safer than those performed femorally when assessing for same-day discharge; however, Naidu stressed that it’s not an automatic qualifier.

“There is some concern about damage to the wrist as opposed to the leg, and people are much more scared about losing any function in their wrist — wrists could have complications,” Naidu said.

But the complication rate has come down dramatically with modern techniques, “and that’s why it’s better,” Naidu said.

Regardless, Ziegelstein said that early intervention in postdischarge issues is the key, which is why all patients are kept at the hospital for some period after these procedures. 

“Every patient is observed for several hours, whether or not they stay overnight. Serious complications are uncommon once that period has passed,” Ziegelstein said.

Like Naidu, Ziegelstein said primary care providers should advise their patients going in for these procedures to call 911 for chest pain, shortness of breath, loss of consciousness, severe lightheadedness, or significant bleeding from the access site. 

System-Level Gaps

“When precautions are in place, little should fall through the cracks — but our healthcare system has big (cracks): PCPs are often unaware their patients even had a procedure,” Ziegelstein said. “There’s an important medical instrument we often forget to use — the telephone. The PCP and outpatient cardiologist should know before, during, and after the procedure what’s happening.”

Naidu agreed that communication gaps remain a top threat to patient safety. 

“We have strong data that same-day discharge can be safe,” he said, “but safety on paper depends on systems in practice. If the discharge summary doesn’t reach the primary care office that day, or no one’s assigned to review next-morning labs, that’s where adverse events sneak in.”

Both physicians pointed to secure messaging through the electronic health record and other clinical decision-support tools as ways to strengthen coordination. 

“Communication with outpatient healthcare providers should be part of every postprocedure checklist,” Ziegelstein said. “That’s how we close the gaps that still exist in same-day discharge care.”

Naidu and Ziegelstein reported having no disclosures.