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Introduction Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is recommended by national guidelines and is associated with improved patient flow and reduced healthcare costs, without compromising patient safety. We evaluated the rate, safety and cost-effectiveness of SDD following elective PCI at a large tertiary centre and compared institutional reporting with national benchmarks.Methodology We conducted a retrospective analysis of 116 consecutive patients who underwent planned elective PCI at Queen Elizabeth Hospital Birmingham (QEHB) between April 2024 and June 2020. Demographic, clinical, procedural, and outcome data were collected from electronic records. High-risk PCI was defined as PCI involving Chronic Total Occlusion (CTOs), left main coronary artery lesions, or three-vessel disease, with procedural risk stratified using the BCIS-CHIP score. Safety outcomes were assessed at 30 days and 6 months. The primary study endpoint was a composite of Major Adverse Cardiac Events (MACE), defined as all-cause mortality, non-fatal myocardial infarction (MI), and unplanned cardiac readmission. A cost-effectiveness analysis was conducted to compare the estimated costs of overnight admission versus SDD and to evaluate the annual financial impact on the hospital.Results The mean age was 66.4 ± 9.3 years (range 41–84), and 76.7% (n = 89) of patients were male. Cardiovascular risk factors included hypertension, present in 51.7% (n = 60) and diabetes mellitus in 35.3% (n = 41). A history of TIA or stroke was documented in 4.3% (n = 5). Previous PCI had been performed in 57.8% (n = 67) and prior CABG in 19.0% (n = 22). Chronic kidney disease (CKD) was present in 14.9% (n = 17). The mean eGFR was 71.6 ± 20 mL/min/1.73 m 2. No patients required routine pre-procedural admission for hydration, and no cases of contrast-induced nephropathy (CIN) requiring prolonged inpatient monitoring were needed. Radial access was the predominant approach (75.0%, n = 87), followed by femoral access (19.8%, n = 23), with jugular or ulnar access used in a minority of cases (5.1%, n = 6). Most cases were scheduled as overnight admissions (91.4%, n = 106), while only a small number of cases were initially planned as day-case procedures (8.6%, n = 10). The rate of SDD was 32.8% (38/116). Only one patient (0.9%) initially planned for SDD required conversion to overnight admission due to a periprocedural myocardial infarction (MI), demonstrating a very low escalation rate.At 30-day follow-up, 98.3% of patients were free from composite adverse events. Two patients (1.7%) in the overnight-admission group experienced unplanned cardiac readmissions for recurrent chest pain; there were no reported deaths or non-fatal MI. At 6-month follow-up, 96.6% of patients remained event-free; two patients (1.7%) had unplanned cardiac readmissions, and two patients (1.7%) developed non-fatal MI (figure 1).High-risk PCI accounted for 28.4% of cases (33/116), with a median CHIP-PCI score of 2 (IQR: 1 – 3). These procedures predominantly involved left main interventions (48.5%, n = 16), chronic total occlusions (36.4%, n = 12) with a median J-CTO score of 2 (IQR: 1 – 3), and multivessel PCI involving ≥3 vessels (6.1%, n = 2). Of the patients undergoing high-risk PCI, 9 (27.3%) were discharged on the same day, with no adverse events observed at either 30 days or 6 months. The remaining 24 patients (72.7%) were admitted overnight for observation; of these, two were readmitted within 6 months with non-fatal MI (NSTEMI) and two with unplanned cardiac readmission for recurrent chest pain, respectively. In the non–high-risk PCI group (n = 82), 51 patients (62.2%) were admitted overnight despite meeting BCIS eligibility criteria for same-day discharge (SDD). None of these patients experienced adverse events, indicating no additional clinical benefit from routine overnight admission (table 2).The estimated cost per patient was £5,941 for overnight admission compared with £2,464 for SDD, resulting in a cost difference of £3,477 per case. Avoidable overnight admission of eligible non-high-risk PCI cases represented a potential saving of £177,327, with a further £83,448 attributable to the stable high-risk PCI cases, equating to £260,775 of savings annually.Conclusion SDD following elective PCI is safe, feasible, and highly cost-effective, including in carefully selected patients undergoing high-risk PCI. Readmissions cost the NHS more than primary admissions. Implementation of structured SDD pathways for uncomplicated PCI has the potential to enhance patient experience, significantly increase SDD rates towards national benchmarks, improve bed capacity, and deliver substantial financial savings without compromising patient safety. This can be performed by establishing a dedicated cardiac day-case unit or radial lounge or extending ambulatory care hours to facilitate safe SDD of later cases.Abstract 71 Table 1Baselines clinical characteristicsVariablen (%) or Mean ± SDAge (years)66.4 ± 9.3 (range 41–84)Male sex89 (76.7)Hypertension60 (51.7)Diabetes mellitus41 (35.3)Chronic kidney disease17 (14.9)History of TIA/Stroke5 (4.3)Previous PCI67 (57.8)Previous CABG22 (19.0)Age (years)66.4 ± 9.3 (range 41–84)Abstract 71 Table 2Procedural characteristics and safety outcomesCharacteristicSame-Day Discharge (n = 38)Overnight Admission (n = 78)High-risk PCI (LM / CTO / ≥3 vessel disease)9 (27.3%)24 (72.7%)Non-High-Risk PCI30 (36.6%)51 (62.2%)Conversion to overnight admission1 (0.9%)—Clinical outcomes:30-day adverse events– Unplanned Cardiac Readmission02 (1.7%)– Non-fatal MI00– All-cause mortality006-month adverse events– Unplanned Cardiac Readmission02 (1.7%)– Non-fatal MI02 (1.7%)– All-cause mortality00Key message:No in-hospital adverse events occurred among same-day discharge patients, including those undergoing high-risk PCI.At 30-day and 6-month follow-up, 98.3% and 96.6% of patients remained free from composite adverse events, respectively.Abstract 71 Figure 1Comparison of clinical outcomes between SDD and overnight admission