Next Day Discharge After Successful Primary Angioplasty for Acute ST Elevation Myocardial Infarction  An Open Randomized Study "Prague-5"

Radovan, Jirmar; Widimský, Petr; Čapek, Jan; Hlinomaz, Ota; Groch, Ladislav

doi:10.1536/ihj.49.653

Cited by 37 publications

(37 citation statements)

References 9 publications

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“…Early, or even next day, discharge of STEMI patients who received primary-PCI has been shown to be feasible and safe, at least in uncomplicated patients [44]. Given a conservative estimate of at least 600 STEMI patients we receive annually, there will be a saving of more than 1200 acute bed-days per year just from the shorter stay during the initial hospitalization.…”

Section: Cost Effectiveness Of Primary-pcimentioning

confidence: 99%

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

Gehani

Suwaidi

Arafa

et al. 2012

Global Cardiology Science and Practice

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In this article, we outline the plans, protocols and strategies to set up the first nationwide primary Percutaneous Coronary Intervention (PCI) program for ST-elevation myocardial Infarction (STEMI) in Qatar, as well as the difficulties and the multi-disciplinary solutions that we adopted in preparation. We will also report some of the landmark literature that guided our plans. The guidelines underscore the need for adequate number of procedures to justify establishing a primary-PCI service and maintain competency. The number of both diagnostic and interventional procedures in our centre has increased substantially over the years. The number of diagnostic procedures has increased from 1470 in 2007, to 2200 in 2009 and is projected to exceed 3000 by the end of 2012. The total number of PCIs has also increased from 443 in 2007, to 646 in 2009 and 1176 in 2011 and is expected to exceed 1400 by the end of 2012. These figures qualify our centre to be classified as ‘high volume’, both for the institution and for the individual interventional operators. The initial number of expected primary PCI procedures will be in excess of 600 procedures per year. Guidelines also emphasize the door to balloon time (DBT), which should not exceed 90 minutes. This interval mainly represents in-hospital delay and reflects the efficiency of the hospital system in the rapid recognition and transfer of the STEMI patient to the catheterization laboratory for primary-PCI. Although DBT is clearly important and is in the forefront of planning for the wide primary PCI program, it is not the only important time interval. Myocardial necrosis begins before the patient arrives to the hospital and even before first medical contact, so time is of the essence. Therefore, our primary PCI program includes a nationwide awareness program for both the population and health care professionals to reduce the pre-hospital delay. We have also taken steps to improve the pre-hospital diagnosis of STEMI. In addition to equipping all ambulances to perform 12-lead electrocardiograms (ECGs) we will establish advanced wireless transmission of the ECG to our Heart Centre and to the smart phone of the consultant on-call for the primary-PCI service. This will ensure that the patient is transferred directly to the cath lab without unnecessary delay in the emergency rooms. A single phone-call system will allow the first medic making the diagnosis to activate the primary PCI team. The emergency medical system is acquiring capability to track the exact position of each ambulance using GPS technology to give an accurate estimate of the time needed to arrive to the patient and/or to the hospital. We also plan for medical helicopter evacuation from remote or inaccessible areas. A comprehensive research database is being established to enable specific pioneering research projects and clinical trials, either as a single centre or in collaboration with other regional or international centers. The primary-PCI program is a collaborative effort between the Heart Hospital, ...

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Section: Cost Effectiveness Of Primary-pcimentioning

confidence: 99%

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

Gehani

Suwaidi

Arafa

et al. 2012

Global Cardiology Science and Practice

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“…Recent reports make clear that large groups of patients can be discharged safely at or within 48 h [6, 9, 10], while the present guidelines recommend discharge after a minimum of 3 d [1, 2]. In addition, a lot of international variation in hospital admission duration among low-risk PPCI patients still exists [3, 17–19].…”

Section: Discussionmentioning

confidence: 99%

NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge

et al. 2016

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BackgroundThe Zwolle Risk Score (ZRS) identifies primary percutaneous coronary intervention (PPCI) patients at low mortality risk, eligible for early discharge. Recently, this score was improved by adding baseline NT-proBNP. However, the optimal timepoint for NT-proBNP measurement is unknown.MethodsPPCI patients in the On-Time 2 study were candidates. The ZRS and NT-proBNP levels on admission, at 18–24 h, at 72–96 h, and the change in NT-proBNP from baseline to 18–24 h (delta NT-proBNP) were determined. We investigated whether addition of the different NT-proBNP measurements to the ZRS improves the prediction of 30-day mortality. Based on cut-off values reflecting zero mortality at 30 d, patients who potentially could be discharged early were identified and occurrence of major adverse cardiac events (MACE) and major bleeding until 10 d was registered.Results845 patients were included. On multivariate analyses, NT-proBNP at baseline (HR 2.09, 95% CI 1.59–2.74, p < 0.001), at 18–24 h (HR 6.83, 95% CI 2.94–15.84), and at 72–96 h (HR 3.32, 95% CI 1.22–9.06) independently predicted death at 30 d. Addition of NT-proBNP to the ZRS improved prediction of mortality, particularly at 18–24 h (net reclassification index 29%, p < 0.0001, integrated discrimination improvement 17%, p < 0.0001). Based on ZRS (<2) or NT-proBNP at 18–24 h (<2500 pg/ml) 75% of patients could be targeted for early discharge at 48 h, with expected re-admission rates of 1.2% due to MACE and/or major bleeding.ConclusionsNT-proBNP at different timepoints improves prognostication of the ZRS. Particularly at 18–24 h post PPCI, the largest group of patients that potentially could be discharged early was identified.Electronic supplementary materialThe online version of this article (doi: 10.1007/s12471-016-0935-2) contains supplementary material, which is available to authorized users.

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“…They define early discharge as discharge on the same day as the intervention. The remaining four studies have patients with STEMI 13,14,19,21. Their definition of early discharge was discharge between 48 and 72 hours after the intervention.…”

Section: Methodsmentioning

confidence: 99%

Early discharge compared with ordinary discharge after percutaneous coronary intervention – a systematic review and meta-analysis of safety and cost

Abdelnoor

Andersen

Arnesen

et al. 2017

VHRM

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AimWe aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies.MethodsThe study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days.ResultsFor early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52–0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88–1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge.ConclusionThe pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.

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Next Day Discharge After Successful Primary Angioplasty for Acute ST Elevation Myocardial Infarction An Open Randomized Study "Prague-5"

Cited by 37 publications

References 9 publications

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge

Early discharge compared with ordinary discharge after percutaneous coronary intervention – a systematic review and meta-analysis of safety and cost

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Next Day Discharge After Successful Primary Angioplasty for Acute ST Elevation Myocardial Infarction An Open Randomized Study "Prague-5"

Cited by 37 publications

References 9 publications

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

NT-proBNP during and after primary PCI for improved scheduling of early hospital discharge

Early discharge compared with ordinary discharge after percutaneous coronary intervention &ndash; a systematic review and meta-analysis of safety and cost

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Early discharge compared with ordinary discharge after percutaneous coronary intervention – a systematic review and meta-analysis of safety and cost