"Hospitals can improve patient care and reduce costs associated with coronary angioplasty if cardiologists perform more of these procedures through an artery in the wrist and if they take steps to discharge such patients on the same day according to a new study led by Washington University School of Medicine in St. Louis. Coronary angioplasty is a procedure in which arteries are opened to increase blood flow to the heart. The research published Feb.  in JACC Cardiovascular Interventions suggests that the lower costs of the wrist approach largely are due to the fact that patients experience fewer complications and can be discharged earlier compared with procedures that access the heart through the larger deeper artery in the groin. The researchers estimated that shifting standard practice by  percent to the wrist approach along with sameday discharge could save the United States  million per year. We have unequivocal evidence and data that show better outcomes when we access the hearts coronary arteries and perform angioplasty through a blood vessel in the wrist rather than through the femoral artery in the groin said first author Amit P. Amin MD an assistant professor of medicine. The femoral artery is the traditional route but when we go in through a vessel in the wrist we see less bleeding fewer complications less pain and discomfort higher patient satisfaction shorter hospital stays and lower costs. Patients may undergo coronary angioplasty  also called percutaneous coronary intervention PCI  to alleviate chest pain or shortness of breath. Such symptoms suggest the coronary arteries that deliver blood to the heart are blocked or narrowed and oxygen delivery to the heart muscle is reduced. Interventional cardiologists insert a small tube into an artery in the wrist or the groin which can be used to view the narrowed heart artery deliver an inflatable balloon to open up the narrowed section and possibly deliver a stent to hold the vessel open. Using the National Cardiovascular Data Registry CathPCI Registry the researchers analyzed data from almost  Medicare patients who underwent PCI and were eligible for sameday discharge. Despite the fact that all of these patients were capable of leaving the hospital the same day as their procedures only about  percent of these patients actually were discharged without having stayed overnight. We have seen that it is very safe to send these patients home the same day said Amin who treats patients at BarnesJewish Hospital. We use riskprediction models to predict their risks ahead of time and we plan ahead to mitigate any issues so we can facilitate a sameday discharge. This is really about patient care. We want to outline healthcare pathways that provide the best care for patients. The analysis demonstrated an average cost of  for the wrist approach with sameday discharge compared with  for the groin approach with at least one night of hospitalization resulting in a cost savings of about  for outpatients who get the wristaccess procedure. Independent of the length of stay the wrist approach costs about  less than the groin approach on average. The investigators estimated that if a hospital performing  of these procedures annually shifted  percent of these patients to the wristaccess with sameday discharge approach the hospital would save  million over that period. Expanding that practice to hospitals nationwide might save the United States  million in healthcare spending per year. Healthcare costs for the  patients who receive PCI each year in the U.S. are estimated to be  billion. Of the studys patient population receiving PCI  percent received the procedure in which doctors used wrist access. According to Amin improved technology has allowed wrist access to become a viable route to the coronary arteries even for complex cases and should be considered for more patients. The traditional way has been to go through the bigger femoral artery that is a straight pathway to the heart Amin said. Unfortunately that artery is also deep. Its associated with more bleeding complications. In contrast the wrist artery is small and is associated with fewer complications. The minor challenge is in the difficulty of navigating a smaller more twisting path of an artery through the wrist. But with advances we have in technology and equipment those challenges are rapidly decreasing.  This work was supported by a grant from Vita Solutions a subsidiary of The Medicines Company for whom Amin has provided consultation and by the National Institutes of Health NIH grant numbers ULTR KLTR TLTR and KMCA. Amin also reported consulting for Terumo. Coauthors from other institutions reported receiving grant funding from or providing consultations to the National Institutes of Health the American College of Cardiology Foundation Eli Lilly Amorcyte Gilead Genentech UnitedHealthcare Amgen Janssen Health Outcomes Sciences Blue Cross Blue Shield of Kansas City Edwards Lifesciences Medtronic St. Jude Medical Abbott Vascular Saint Lukes Hospital Foundation of Kansas City partially funded by Merck Boston Scientific Biomet Daiichi Sankyo AstraZeneca and Bellerophon. Amin AP Patterson M House JA Giersiefen H Spertus JA Baklanov DV Chhatriwalla AK Safley DM Cohen DJ Rao SV Marso SP. Costs associated with access site and sameday discharge among Medicare beneficiaries undergoing percutaneous coronary intervention. JACC Cardiovascular Interventions. Feb.  . Washington University School of Medicines  employed and volunteer faculty physicians also are the medical staff of BarnesJewish and St. Louis Childrens hospitals. The School of Medicine is one of the leading medical research teaching and patientcare institutions in the nation currently ranked sixth in the nation by U.S. News  World Report. Through its affiliations with BarnesJewish and St. Louis Childrens hospitals the School of Medicine is linked to BJC HealthCare."