Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction

Abstract

Background: To assess safety of early discharge following primary percutaneous coronary intervention (PPCI) for STelevation myocardial infarction (STEMI). Methods and results: Retrospective analysis of prospectively collected data of 2448 STEMI patients treated with PPCI surviving to hospital discharge. Post-discharge all-cause mortality was reported at 1, 7, and 30 days and long-term follow up. A total of 1542 patients (63.0%) were discharged within 2 days of admission (early discharge group) and 906 patients (37.0%) after 2 days (late discharge group). In both groups, no deaths were recorded 1 day post discharge. The early and late discharge group mortality figures for 7 days were 0 and 4 patients (0.04%) and between 7 and 30 days were 11 (0.7%) and 11 patients (1.2%), respectively. During a mean follow up of 584 days, 178 patients (7.3%) died: 67 in the early discharge group (4.3%) and 111 in the late discharge group (12.3%). Conclusions: This exploratory, observational study demonstrates that discharging low-risk STEMI patients within 2 days following PPCI is safe. For providers of health care, early discharge can help to allay the cost of providing a 24-hour PPCI service and adds to the recognized benefits arising from PPCI.

Feasibility and Safety of an Early Discharge Strategy after Low-Risk Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: The EDAMI Pilot Trial

“…Noman et al [13] recently analyzed retrospective data on 2,448 STEMI patients treated with pPCI and suggested that an EDS (63% of patients were discharged within 48 h) is safe for low-risk subjects (4.3% mortality after a mean follow-up of 584 days), as identified by the physician's clinical judgment. To the best of our knowledge, only 2 small randomized clinical trials have previously addressed the feasibility and safety of an EDS over a CDS in patients with low-risk STEMI treated with pPCI.…”

Identifying patients for safe early hospital discharge following st elevation myocardial infarction

“…According to professional society guidelines, those at low risk may be discharged by 72 hr; however, this recommendation is based predominantly on data from patients treated with fibrinolysis . The risk of discharging low risk patients following primary PCI earlier than 72 hr is not known, and prolonging hospitalization in low risk patients to achieve a minimum observation period may increase hospital costs without conferring a substantial benefit to the patient . Randomized trials that investigated an early discharge strategy have been small and underpowered and thus have been inadequate to inform clinical practice .…”

Almanac 2013: acute coronary syndromes

“…Two new studies have demonstrated that discharging low risk STEMI patients within 2 days following primary PCI is safe and feasible 34 35. Over 40% of the STEMI patients in one of the studies met early discharge criteria 34.…”