title: Same-day discharge after coronary stenting: a feasibility study using a hemostatic femoral puncture closure device.
abstract: A major limiting factor for percutaneous coronary interventions carried out via the femoral route is the time it takes to achieve femoral artery hemostasis and subsequent mobilization. Discharge from hospital usually occurs the following day. In this pilot study, we assessed the feasibility of mobilization at 4 hours and same-day discharge from hospital of selected elective patients undergoing intracoronary stenting using the Angio-Seal Vascular Closure device. Seventy-five patients (56 +/- 10 years) with stable single-vessel coronary disease scheduled for elective coronary stenting were enrolled. All patients were mobilized at 4 hours and assessed at 10 hours postprocedure as to their suitability for hospital discharge. The first 50 patients remained in hospital overnight. The next 25 patients followed the same procedures but were discharged at 10 hours. The subjects were followed up at 48 hours and 30 days. Hemostasis was achieved in all patients following sheath removal and deployment of the Angio-Seal device. Twenty patients (27%) had minor groin oozing and two developed small hematoma. There were no major bleeding complications, pseudoaneurysm, vascular surgery, or groin infection. Groin oozing resulted in the delay of ambulation for 13 subjects but discharge was not delayed in any patient. All patients were reported to be suitable for hospital discharge at 10 hours postprocedure. There were no further complications at 30 days. The present study demonstrated that early mobilization and same-day discharge after coronary stenting using the Angio-Seal device is feasible in selected patients. Further studies are needed to determine the patient selection criteria and the potential cost-saving implications of this strategy.
authors.affiliation: Division of Cardiology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
authors.forename: Kok-Meng
authors.initials: KM
authors.lastname: Yee
authors.forename: Charles
authors.initials: C
authors.lastname: Lazzam
authors.forename: Jan
authors.initials: J
authors.lastname: Richards
authors.forename: John
authors.initials: J
authors.lastname: Ross
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018579:Patient Selection; D010865:Pilot Projects; D015607:Stents; D016896:Treatment Outcome