Association of Acute Kidney Injury Risk and Same-Day Discharge Practices After Percutaneous Coronary Intervention.

BACKGROUND: Same-day discharge (SDD) after percutaneous coronary intervention (PCI) may be altered when complications occur. We sought to determine whether risk of the most common complication, acute kidney injury (AKI), is associated with SDD in practice. METHODS: Using the NCDR (National Cardiovascular Data Registry) CathPCI registry, we calculated the AKI risk for elective PCIs from 2018 to 2022 using the NCDR prediction model. Hierarchical logistic regression models were constructed to predict SDD with AKI risk and procedural variables as fixed effects, and site as a random effect. Trends in SDD rate across AKI risk categories were described and variability across sites was quantified using median odds ratios (ORs). RESULTS: Among 1 033 096 eligible patients, 414 297 (40.1%) had SDD after PCI and rates increased throughout the study period (27.9% in 2018 to 53.4% in 2022; 1.9% per quarter). Higher AKI risks were associated with lower SDD rates (OR, 0.97 per 1% increase in AKI risk [95% CI 0.968-0.971]) although even in 2022, 41.2% of high-risk patients underwent SDD. Marked variation in SDD practices was observed across sites (overall median OR, 3.75 [95% CI 2.63-5.34]) even among the highest risk group (median OR, 3.60 [95% CI 2.34-5.56]). CONCLUSIONS: Although patients at higher risk of AKI are less likely to undergo SDD overall, currently, 2 in 5 patients with >10% AKI risk are discharged the day of their procedure with marked variation across sites. Further work is needed to better understand the postdischarge risk of SDD in patients at higher AKI risk to improve delivery and safety of PCI.

Duke Scholars

Author Jennifer Anne Rymer Medicine, Cardiology

Author Rebecca Young