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Outpatient coronary stenting: femoral approach with vascular sealing
J R Wilentz1, G Mishkel, D McDermott
1Beth Israel Medical Center, New York, NY, USA. jwilentz@att.net
Insights
Outpatient coronary stenting with vascular sealing is feasible and safe. This approach reduces patient recovery time and costs, potentially saving millions annually.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Economics
Background:
- Coronary interventions are increasingly utilizing miniaturized devices to enhance patient convenience and reduce costs.
- Shorter hospital stays are a key objective in modern interventional cardiology.
Purpose of the Study:
- To evaluate the feasibility and safety of outpatient coronary stenting using vascular sealing devices.
- To assess the impact of this strategy on patient recovery times and healthcare costs.
Main Methods:
- A cohort of 60 patients with stable/unstable angina or recent myocardial infarction underwent outpatient stenting with vascular sealing.
- Patients were divided into 6F and 7-8F sheath size groups.
- Outcomes measured included time to hemostasis, ambulation, discharge, and access site complications.
Main Results:
- No acute procedural or ischemic complications were observed at 24 hours or 1 month.
- Mean hemostasis, ambulation, and discharge times were significantly shorter for the 6F group compared to the 7-8F group.
- One pseudoaneurysm required surgical correction; other access sites had no complications. Cost savings were estimated at $478 (6F) and $437 (8F) per procedure.
Conclusions:
- Outpatient stenting with vascular sealing is a safe and feasible strategy for selected patients.
- This approach offers significant potential for nationwide cost reduction in cardiovascular interventions.
Abstract:
Miniaturized devices and pressures for increased patient convenience and lowered cost have shortened length of stay for coronary interventions. A cohort of 60 patients was recruited to assess the feasibility of outpatient stenting with vascular sealing. Patients with stable and unstable angina or myocardial infarction > 24 hours were considered for this strategy. Mean time to hemostasis, ambulation and discharge were 6.1, 256 and 296 minutes, respectively, for the 6F group, and 11.0, 351 and 489 minutes for the 7 to 8F group. No acute procedural complications occurred, and there were no ischemic complications at 24 hours or 1 month. There was 1 pseudoaneurysm requiring surgical correction, but no other access site requiring treatment. The cost saved using the 6F approach is estimated at $478 and using the 8F approach, $437. Outpatient stenting using vascular sealing is feasible and safe, and may lead to significant nationwide cost reductions in the range of $40,000,000 yearly.