Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials

Abstract

Background Early discharge after successful primary angioplasty is common, but the evidence supporting the practice is still lacking. We therefore performed a meta-analysis assessing the safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction (STEMI). Methods Randomised controlled trials were identified and extracted from PubMed, Embase, Cochrane Library databases and reference lists of relevant papers. Heterogeneity was analysed using the I test. If there was a lack of heterogeneity, fixed effects models would be used for the meta-analysis, otherwise random effects models were used. Statistical analyses were performed using Review Manager 5.3. Results Five randomised controlled trials involving 1575 STEMI patients met the criteria. Meta-analysis showed that the early discharge strategy group had a significantly shortened length of hospital stay compared to the conventional discharge strategy group (standardised mean difference -1.46, 95% confidence interval (CI) -2.04 to -0.88; P < 0.0001), and there was no difference in mortality and readmission rates between the two groups (risk ratio 0.78, 95% CI 0.50 to 1.22; P = 0.41). Conclusions The findings of this meta-analysis suggested that the early discharge strategy after successful primary angioplasty is safe among selected low-risk STEMI patients. A shorter hospital stay could benefit both the patients and the healthcare systems.

Left Ventricular Ejection Fraction along with Zwolle Risk Score for Risk Stratification to Enhance Safe and Early Discharge in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Observational Study

“…Early discharge using CADILLAC risk score showed lower mortality at day three or later in patients with lower risk score post PCI in STEMI [26]. Meta-analysis of five randomized controlled studies involving 1575 STEMI patients demonstrated the safety of early discharge in low-risk STEMI post primary PCI benefiting both patients and the healthcare system [27].…”

Editor’s presentation

“…4 Here, a meta-analysis which included five randomised controlled trials on early discharge in patients with STEMI treated with primary coronary angioplasty (1575 patients in total) confirmed that shortening the length of stay was safe, with no detrimental effect on mortality and readmission rates. 5…”

Early discharge (within 24–72 h) in low-risk AMI patients treated with PCI: feasibility and safety—Hajj study

“…Our tertiary center is the only cardiac center in the region providing tertiary care facility including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) and hence receives all AMI patients deemed suitable for invasive assessment and management and this leads to huge demand on cardiac services over the few weeks of hajj time. Reduced hospital stay has been proved to reduce the hospital burden and costs [ 12 – 15 ].…”