TCT-274 A Randomized Prospective Study of Same Day Discharge after Coronary Artery Stenting and Facilitated Femoral Hemostasis with a Closure Device

  • Clavijo L
  • Cortes G
  • Jolly A
  • et al.
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Abstract

Background: Despite advances in interventional cardiology, and that safety and feasibility of outpatient percutaneous coronary intervention (PCI) has been previously demonstrated, overnight stay after PCI remains the standard of care in the United States. The study aims to compare outcomes, patient satisfaction, and cost of same day (SD) vs. delayed hospital discharge (DD) after PCI‐stenting and femoral hemostasis with a vascular closure device (StarClose or ProGlide). Methods: Consecutive patients undergoing coronary angiography (n=2,480) at University of Southern California Hospitals were screened; 493 patients were consented for inclusion. Four hours following PCI 100 patients were randomized to SD (n=50) or DD (n=50). Patients were followed for one month and patient satisfaction surveys completed at 24 hours and one‐month post discharge. Cost savings were calculated based on Medicare payment rates. Results: SD and DD groups were well distributed with similar baseline demographic and angiographic characteristics. Mean age was 58.1+/‐8.8, 86% were male, % smokers, % diabetic, % had history of MI and 31% CRI. NSTEMI or unstable angina (UA) was the presentation in 30% of SD vs. 44% of DD patients (p=0.2) and all other patients had stable angina (SA) (70% in DD vs. 56% in SD, p=0.15). Multivessel stenting was performed in 74% and 60% of SD and DD groups, respectively (p=0.14). At 30 days post‐discharge, the primary end point (death, myocardial infarction or repeat revascularization) occurred in one DD patient (2%) vs. two SD patients (4%), p=1.0. The secondary end points of major non‐CABG related bleeding occurred in one SD patient (GI bleed) and recurrent hospitalization in three patients of SD (6%) vs. one DD patient (2%), p=0.62. There were no vascular complications. Patient satisfaction scores were equivalent in both groups at all time points. SD was associated with $1,200 savings per patient. Conclusions: Same day discharge after uncomplicated single and multivessel PCI of patients with SA, UA and low risk NSTEMI facilitated by vascular device closure is associated with similar clinical outcomes, patient satisfaction and significant cost savings compared to traditional overnight hospital stay.

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APA

Clavijo, L. C., Cortes, G. A., Jolly, A., Wagman, B., Shavelle, D., Mehra, A., … Matthews, R. (2013). TCT-274 A Randomized Prospective Study of Same Day Discharge after Coronary Artery Stenting and Facilitated Femoral Hemostasis with a Closure Device. Journal of the American College of Cardiology, 62(18), B89–B90. https://doi.org/10.1016/j.jacc.2013.08.1010

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