When can we discharge patients after chronic total occlusion percutaneous coronary intervention?

Implementing same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is associated with important cost savings1 and might also improve patient flow through the hospital. SDD has been steadily growing in certain environments (e.g., approximately one-third of elective PCIs in the USA in 20172), in parallel with the adoption of radial access12. The introduction of SDD has not correlated with worse overall clinical outcomes12, indicating its safety in specific scenarios. There seems to be a large between-hospital variation in SDD rates12, suggesting the existence of logistical and clinical practice-related barriers to a homogeneous adoption of SDD.

Chronic total occlusion (CTO) PCI has witnessed a remarkable growth over the past decade. Implementing an SDD strategy after CTO PCI is appealing for the same reasons as after PCI in all-comers, yet its implementation is hampered by unique challenges, including higher use of femoral access, contrast volume, and risk of procedural complications.

Small single-centre studies from the USA3 and Greece4 recently reported on the feasibility of SDD after CTO PCI. SDD was adopted in 41.7%...