Safety and Feasibility of Hospital Discharge 2 Days Following Primary Percutaneous Intervention for ST-Segment Elevation Myocardial Infarction

Study Questions:

What is the safety and feasibility of discharge at 2 days following primary percutaneous coronary intervention (PCI) in selected low-risk cases?

Methods:

The authors assessed the outcome of 2,779 patients who underwent primary PCI between 2004 and 2011 at a single hospital in London. Patients meeting the following criteria were deemed suitable for very early discharge; Thrombolysis in Myocardial Infarction (TIMI) III flow, left ventricular ejection fraction >40%, and rhythmic and hemodynamic stability out to 48 hours, although the final discharge decision was at the discretion of the treating physician. Higher-risk patients who did not fulfill these criteria were discharged later according to physician preference. All patients were offered outpatient follow-up by a multidisciplinary team within 1 week. The study endpoints included 30-day readmission rates and major adverse cardiac events (MACE) out to a median of 2.8 years.

Results:

Of the total cohort, nearly one half (49.3%) met very early discharge criteria, and of these, 1,117 (85.3%) were actually discharged at 2 days. Of the remainder, 620 (23.4%) were discharged at 3 days, and 916 (34.5%) had longer hospitalization (median 5, interquartile range 4-8 days). Patients discharged at 2 days were younger, and had lower rates of diabetes, renal dysfunction, multivessel coronary artery disease, previous myocardial infarction, and previous coronary artery bypass surgery.Thirty-day readmission rates for non-MACE events were 4.8%, 4.9%, and 4.6% for patients discharged 2 days, 3 days, and >3 days after admission, respectively. Long-term MACE rates were lowest in patients discharged at 2 days (9.6%) compared with patients discharged at 3 days (12.3%) and >3 days (28.6%) after admission.

Conclusions:

The authors concluded that a significant number of patients can be safely discharged 2 days after primary PCI.

Perspective:

Patients who undergo successful primary PCI and have a preserved ejection fraction have an excellent outcome, and this study suggests that they can be discharged safely from the hospital. This study corroborates prior work suggesting the safety of very early discharge after primary PCI (Safe–Depart trial, Am Heart J 2010; median time to discharge, 55 hours), a practice that is likely more prevalent than generally recognized.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Safety, Outpatients, London, Coronary Artery Bypass, Patient Discharge, Hospitalization, Diabetes Mellitus, Percutaneous Coronary Intervention


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