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.
Zusammenfassung
Die zunehmende Miniaturisierung der interventionellen Geräte und der steigende Patientenwunsch nach komfortablen äußeren Umständen sowie die reduzierte Kostenerstattung haben die Dauer des stationären Aufenthaltes nach Koronarinterventionen verkürzt.
Wir haben bei 60 Patienten die Durchführbarkeit und Sicherheit der ambulanten PTCA mit Stentimplantation unter Verwendung arterieller Verschlußsysteme untersucht. Eingeschlossen wurden Patienten mit stabiler und instabiler Angina pectoris sowie Zustand nach Myokardinfarkt (> 24 Stunden).
Die mittlere Hämostasezeit, Mobilisationszeit und Entlassungszeit waren 6,1,256 und 296 Minuten in der Gruppe mit 6F-Schleusen und 11,351 und 498 Minuten in der mit 7F–8F-Schleusen. Akute Komplikationen während der Koronarintervention traten nicht auf. Nach 24 Stunden und einem Monat wurden keine ischämischen Komplikationen beobachtet. Bei einem Patienten trat ein Pseudoaneurysma auf, welches eine operative Korrektur erforderlich machte, ansonsten war keine spezielle Behandlung der arteriellen Punktionsstelle erforderlich. Die Kostenersparnis bei 6F betrug im Durchschnitt US-$ 478, bei 8F US-$ 437.
Die ambulante PTCA mit Stentimplantation unter Verwendung eines arteriellen Verschlußsystems ist durchführbar und sicher. Dieses Vorgehen könnte in den USA jährlich Kosten von 40 Mio US-$ einsparen.
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Wilentz, J.R., Mishkel, G., McDermott, D. et al. Outpatient coronary stenting: Femoral approach with vascular sealing. Herz 24, 624–633 (1999). https://doi.org/10.1007/BF03044487
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DOI: https://doi.org/10.1007/BF03044487