Overnight Stay May Not Be Necessary for Stenting: Study
TUESDAY Oct. 4, 2011 -- Heart patients who have stenting procedures to open up narrowed arteries fare just as well if they are released the same day as if they are sent home a day or two later, new research shows.
"[Discharging patients the same day] wasn't associated with any increased risk at all," said Dr. Sunil V. Rao, lead author of a study appearing in the Oct. 5 issue of the Journal of the American Medical Association. "We were surprised. Not only were the results similar but . . . they were almost identical."
The current practice at most centers is to keep patients overnight for observation.
"[Same-day discharge] is long overdue," added Dr. Craig Narins, professor of medicine at the University of Rochester School of Medicine. "Some of the recent advances in angioplasty have made the procedure so safe and, for select patients, the likelihood of immediate complications are just so low it just makes sense to do this. It's definitely the wave of the future."
The biggest advance, said Narins, is the procedure is now done through the radial artery (in the wrist) rather than the femoral artery (in the thigh).
"That makes the likelihood of vascular/bleeding complications very, very low after the procedure," he said.
Stenting procedures, or percutaneous coronary intervention (PCI), involve placing a balloon (balloon angioplasty) or a stent in a narrowed coronary artery to open it up and ease blood flow.
More than 1 million of these procedures are performed each year among Medicare beneficiaries, making it one of the most common medical procedures in the United States.
Other countries, including many in Europe as well as India and Canada, are already doing the procedure on an outpatient basis, noted Rao, who is associate professor of medicine at Duke University Medical Center in Durham, N.C.
The safety of stenting as an outpatient procedure has been backed by smaller studies, but this study is the first to look at many centers at once, all told treating more than 100,000 Medicare recipients.
The researchers found no major differences in mortality or readmission to the hospital after same-day stenting either right after the procedure or 30 days later.
The bleeding rate was extremely low -- only 1 percent -- and the same in both groups of patients.
But the authors only looked at very low-risk patients, those who were undergoing elective PCI and who had not arrived in the emergency room with blaring ambulance lights and in the midst of a heart attack.
And if hospitals and heart centers are going to adopt this practice, it's important that they have in place education strategies and telephone numbers for patients to call if they have a question or problem.
"It's a program. It's not just, 'Oh, you're low risk. We're going to get you out of the door,'" said Rao, who is also director of Duke's Cardiac Catheterization Lab.
Narins' hospital started a same-day stenting protocol about six months ago that does include such safeguards.
"We're starting off with patients who are pretty healthy to begin with. These are simple and straightforward angioplasty procedures that go well without complications," he said. "The patients live locally, say within 30 miles of the hospital, and have good support at home. They're not going to be going home by themselves. If something unexpected happens, they'd be able to get in touch with us."
The Radiological Society of North America has more on stenting.
Posted: October 2011
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