Very low risk ST-segment elevation myocardial infarction? It exists and may be easily identified

Díez-Delhoyo, Felipe; Valero‐Masa, María Jesús; Velásquez‐Rodríguez, Jesús; Devesa-Cordero, Carolina; Sousa‐Casasnovas, Iago; Juárez, Míriam; Angulo-Llanos, Rocío; Fernández-Avilés, Francisco; Martínez‐Sellés, Manuel

doi:10.1016/j.ijcard.2016.11.276

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…Dı´ez-Delhoyo et al recently reported that a 24-48-hour inhospital stay is a feasible alternative in very low-risk STEMI patients. 7 In our opinion, further and larger studies, especially clinical trials, are needed to define specific discharge timings for the current situation.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Increasing attention has recently been given to identifying low-risk groups of patients in whom an early discharge strategy would be feasible and safe. 7 This may lead to a decrease in the length of hospital stay, and subsequently save healthcare resources. In addition, some studies have reported that the early discharge strategy can reduce the incidence of inhospital complications.…”

Section: Introductionmentioning

confidence: 99%

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

Gong

et al. 2018

Eur J Prev Cardiolog

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gong

et al. 2018

Eur J Prev Cardiolog

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“…Despite adjusting for the participation of each hospital in the treatment chain model, it is difficult to avoid “unfair” results when comparing hospitals that mostly receive patients in the most acute and critical stage with those that receive far more patients who are fit to be transferred ( 3 ). Different subgroups of patients have different risk patterns, and the selection of patients may influence a hospital's treatment measure ( 14 ). There have been concerns that PCI hospitals, which accept a greater volume of high-risk ST-elevated AMI (STEMI) patients, may have their reported mortality rates adversely affected ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Calculating the 30-day Survival Rate in Acute Myocardial Infarction: Should we Use the Treatment Chain or the Hospital Catchment Model?

Norum

Hansen

Hovland

et al. 2017

Heart International

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IntroductionAcute myocardial infarction (AMI) is a potentially deadly disease and significant efforts have been concentrated on improving hospital performance. A 30-day survival rate has become a key quality of care indicator. In Northern Norway, some patients undergoing AMI are directly transferred to the Regional Cardiac Intervention Center at the University Hospital of North Norway in Tromsø. Here, coronary angiography and percutaneous coronary intervention is performed. Consequently, local hospitals may be bypassed in the treatment chain, generating differences in case mix, and making the treatment chain model difficult to interpret. We aimed to compare the treatment chain model with an alternative based on patients’ place of living.MethodsBetween 2013 and 2015, a total of 3,155 patients were registered in the Norwegian Patient Registry database. All patients were categorized according to their local hospital's catchment area. The method of Guo-Romano, with an indifference interval of 0.02, was used to test whether a hospital was an outlier or not. We adjusted for age, sex, comorbidity, and number of prior hospitalizations.ConclusionsWe revealed the 30-day AMI survival figure ranging between 88.0% and 93.5% (absolute difference 5.5%) using the hospital catchment method. The treatment chain rate ranged between 86.0% and 94.0% (absolute difference 8.0%). The latter figure is the one published as the National Quality of Care Measure in Norway. Local hospitals may get negative attention even though their catchment area is well served. We recommend the hospital catchment method as the first choice when measuring equality of care.

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“…We used the data from the DIAMANTE (Descripción del Infarto Agudo de Miocardio: Actuaciones, Novedades, Terapias y Evolución/Description of Acute Myocardial Infarction: Management, New Therapies and Evolution) registry [12-15] that included consecutive patients with STEMI treated with urgent reperfusion therapy. For the present study, we selected patients with a discharge electrocardiogram (ECG) in sinus rhythm.…”

Section: Methodsmentioning

confidence: 99%

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

et al. 2019

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Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

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Very low risk ST-segment elevation myocardial infarction? It exists and may be easily identified

Cited by 19 publications

References 33 publications

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

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

Calculating the 30-day Survival Rate in Acute Myocardial Infarction: Should we Use the Treatment Chain or the Hospital Catchment Model?

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

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