Author + information
- Received September 6, 1989
- Revision received December 20, 1989
- Accepted January 10, 1990
- Published online June 1, 1990.
- Morton J. Kern, MD, FACC∗∗,
- Marc Cohen, MD, FACC†,
- J.David Talley, MD, FACC‡,
- Frank Litvack, MD§,
- Harvey Serota, MD∗,
- Frank Aguirre, MD∗,
- Ubeydullah Deligonul, MD∗ and
- Thomas M. Bashore, MD, FACC∥
- ↵∗Address for reprints: Morton J. Kern, MD, Cardiac Catheterization Laboratory, St. Louis University Hospital, 3635 Vista Avenue St. Louis, Missouri 63110.
Because earlier ambulation and discharge after cardiac catheterization may result in the increased utilization of outpatient facilities, a prospective five center clinical pilot trial assessing the safety and outcome of early ambulation after routine left heart catheterization was performed in 287 patients. Catheterization routines at each clinical center were unchanged throughout the study. After the diagnostic catheterization using 5 French (F), preformed, large lumen catheters and arterial puncture compression (mean 15 min, range 5 to 52), 260 patients were ambulated by a physician at a mean time of 2.6 h (range 1.8 to 3.1) after catheterization. Follow-up examination or a phone call 24 to 72 h later was performed to assess late results.
The mean age of the patients was 58 years (range 25 to 91);166 (58%) were men. Left ventricular ejection fraction was 54 ± 15%. One hundred twenty-seven patients (44%) received intravenous heparin (1,500 to 5,000 U as an intravenous bolus) and 136 (47%) received aspirin.
Major complications included transient ischemic attack (one patient) and ventricular tachycardia requiring cardio-version during ventriculography (two patients). A small hematoma (<5.0 cm) after ambulation occurred early (from compression to standing) in 14 patients (5%; 9 received heparin, 8 were taking aspirin) and later (after standing to 72 h) in 9 patients (3, 2 receiving heparin, 2 taking aspirin). Five patients with a hematoma had studies with a 6F sheath. No patient required surgical intervention for early or late hematoma. Only three patients (1%) needed a 7F or 8F catheter because of suboptimal 5F coronary angiography. Ninety-two percent of patients had a complete study with the 5F catheters.
These results indicate that early ambulation after large lumen 5F femoral left heart catheterization was safe, with minimal postprocedural complications and without compromising angiographic data quality. Early ambulation has the potential to improve outpatient catheterization cost factors by early discharge and increased facility utilization.
☆ This study was supported in part by a grant from Sherwood Medical Company, St. Louis, Missouri. The participating clinical centers and collaborating investigators are listed in Appendix 2.
- Received September 6, 1989.
- Revision received December 20, 1989.
- Accepted January 10, 1990.