title: Same-day discharge after coronary stenting and femoral artery device closure: A randomized study in stable and low-risk acute coronary syndrome patients.
abstract: OBJECTIVE
  To compare same-day (SD) vs. delayed hospital discharge (DD) after single and multivessel coronary stenting facilitated by femoral closure device in patients with stable angina and low-risk acute coronary syndrome (ACS).
  
  
  METHODS
  University of Southern California patients were screened and coronary stenting was performed in 2480 patients. Four hundred ninety-three patients met screening criteria and consented. Four hours after percutaneous coronary intervention, 100 were randomized to SD (n=50) or DD (n=50). Patients were followed for one year; outcomes-, patient satisfaction-, and cost analyses were performed.
  
  
  RESULTS
  Groups were well distributed, with similar baseline demographic and angiographic characteristics. Mean age was 58.1±8.8years and 86% were male. Non-ST-elevation myocardial infarction and unstable angina were the clinical presentations in 30% and 44% of the SD and DD groups, respectively (p=0.2). Multivessel stenting was performed in 36% and 30% of SD and DD groups, respectively (p=0.14). At one year, two patients from each group (4%) required unplanned revascularization and one patient in the SD group had a gastrointestinal bleed that required a blood transfusion. Six SD and four DD patients required repeat hospitalization (p=0.74). There were no femoral artery vascular complications in either group. Patient satisfaction scores were equivalent. SD discharge was associated with $1200 savings per patient.
  
  
  CONCLUSIONS
  SD discharge after uncomplicated single and multivessel coronary stenting of patients with stable, low-risk ACS, via the femoral approach facilitated by a closure device, is associated with similar clinical outcomes, patient satisfaction, and cost savings compared to overnight (DD) hospital stay.
authors.affiliation: University of Southern California, Los Angeles, CA. Electronic address: lclavijo@usc.edu.
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Clavijo
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Cortes
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Jolly
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Han
authors.initials: H
authors.lastname: Tun
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Anilkumar
authors.initials: A
authors.lastname: Mehra
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: David
authors.initials: D
authors.lastname: Shavelle
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Ray V
authors.initials: RV
authors.lastname: Matthews
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics; D017023:Coronary Angiography; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission; D017060:Patient Satisfaction; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D011446:Prospective Studies; D011677:Punctures; D012307:Risk Factors; D015607:Stents / Q000191:economics; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D065506:Vascular Closure Devices / Q000191:economics
keywords: Coronary stenting; Early discharge; Same-day discharge