Patients 65 or older discharged from the hospital as early as 48 hours after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) have similar outcomes as those who stay four-to-five days, provided there are no in-hospital complications, according to a study published March 23 in the Journal of the American College of Cardiology.

Using data from the ACC's CathPCI Registry linked with Centers for Medicare and Medicaid Services (CMS) claims data, researchers assessed 33,920 patients between January 6, 2004, and December 21, 2009. The team followed CMS guidelines for length of stay and defined a short stay as fewer than three days; a medium stay as four-to-five days; and a long stay as more than five days. A small group of patients with very short stays of one-to-two days was also evaluated.

Researchers noted a trend in shorter hospital stays over the course of the study. In 2005, 24 percent of STEMI patients were discharged early, but by 2009, that number had increased to 30 percent. Similarly, 47 percent of patients had medium stays, and 29 percent had long stays; by 2009, these numbers had decreased to 45 percent and 25 percent, respectively. There was no significant difference in 30-day mortality or major adverse cardiac events between the two groups.

The researchers made several observations about the characteristics of those patients with the longest stays (more than five days): they tended to be older, had more comorbidities, and had more extensive coronary vessel disease than patients with medium or short hospital stays.

On the other hand, little was known about the small number of patients who were discharged early (same day or after an overnight stay). This group had poorer 30-day clinical outcomes, perhaps indicating the need for appropriate inpatient monitoring after the procedure.

Furthermore, geographic variation in the length of hospital stays was observed. Patients in hospitals in the West and Midwest had shorter hospital stays than those in the North and Southeast.

"Our study suggests that early discharge – but not less than 48 hours after PPCI – may be safe among selected older STEMI patients who do not develop post-procedural complications," said Rajesh V. Swaminathan, MD, FACC, assistant professor of medicine at Weill Cornell Medical College and assistant attending physician at New York-Presbyterian Hospital and the study’s lead author. "The results of this study should prompt physicians to take a closer look at the STEMI discharge practices in their own institutions. Many centers, particularly in the North and Southeast, may have the opportunity to shave off at least one hospital day post-PPCI for their low-risk STEMI patients as a way to optimize health care efficiency and bed utilization without compromising clinical outcomes."

In an accompanying editorial, Frederic S. Resnic, MD, MSc, FACC, of the Department of Cardiovascular Medicine at Lahey Hospital and Medical Center in Burlington, MA, notes that the study "helps affirm that the current practice to discharge lower-risk patients early – after about three days – is likely as safe as longer hospital stays. Given the observed geographic variation, there is likely an opportunity to apply this practice more broadly, thereby achieving significant health care cost savings while maintaining the quality of STEMI care."

Keywords: Centers for Medicare and Medicaid Services, U.S., Comorbidity, Coronary Vessels, Health Care Costs, Hospitals, Inpatients, Length of Stay, Medicaid, Medicare, Myocardial Infarction, Patient Discharge, Percutaneous Coronary Intervention, Registries, Research Personnel, CathPCI Registry, National Cardiovascular Data Registries

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