The safety and predictability of percutaneous coronary intervention (PCI) has improved dramatically in the last decade. The increased numbers of patients suitable for the procedures have placed pressure on existing health care systems. Treating patients with chronic stable angina on a day case basis without an overnight stay has several attractions,¹ but there are some concerns over the safety of this approach.

Troponin I is released rapidly following myocardial necrosis, it is highly sensitive, and may be more specific than other enzymatic markers of cardiac damage. Elevation of cardiac markers, mainly creatine kinase-MB, after both elective percutaneous and surgical revascularisation reflects myocardial necrosis and is associated with increased risk of in-hospital and long term adverse events.²

Glycoprotein (Gp) IIb/IIIa inhibitors appear to be particularly beneficial in reducing this complication,³ but day case intervention precludes overnight administration of Gp IIb/IIIa inhibitors.

This audit determined the incidence of serum troponin I elevation after 6–8 hours in patients discharged the same day according to pre-specified clinical, angiographic, and procedural criteria.

METHODS

Two hundred and twenty nine consecutive patients were admitted for elective day case PCI from January to July 2002. This represents 30% of the total PCIs in our institution during this period (n  =  762).

Predetermined clinical and angiographic inclusion and exclusion criteria were …