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9 Early hospital discharge at 48 h following primary PCI for myocardial infarction is both safe and feasible
  1. O Guttmann,
  2. D A Jones,
  3. K S Rathod,
  4. M Akhtar,
  5. A Ludman,
  6. A K Jain,
  7. C Knight,
  8. A Mathur,
  9. S Mohiddin,
  10. A Wragg,
  11. E J Smith
  1. Barts and the London NHS trust, London, UK

Abstract

Introduction Reperfusion therapy with primary PCI (PPCI) has reduced rates of recurrent ischaemia and arrhythmia following ST elevation myocardial infarction (STEMI), resulting in shorter hospital stays. Discharge at 72 h in selected patients has been suggested. We investigated the feasibility and safety of very early discharge (<48 h) coupled with regular outpatient support for low-risk patients following PPCI.

Methods 2317 patients underwent PPCI for STEMI between October 2003 and May 2010 at a regional Heart Attack Centre (HAC). Demographic and procedural data were documented at the time of intervention. Patients with TIMI 3 flow, ST segment resolution, good or moderate left ventricular function, and no dysrhythmia were stratified to 48 h discharge. Remaining patients were discharged according to physician preference. All patients were reviewed at 1, 8 and 52 weeks with a multidisciplinary team including rehabilitation, heart failure, and psychology. The primary endpoint was major adverse cardiac events (MACE) included death, myocardial infarction (MI), stroke and target vessel revascularisation (TVR). All-cause mortality data were provided by the Office of National Statistics via the BCIS CCAD national audit. Outcomes were compared between those discharged at ≤48 h, 72 h, and >72 h, out to 5 years of follow-up.

Results 1079 patients (46.5%) were stratified to 48-h discharge, 14% discharged at 72 h and the remainder discharged at a median of 6 days (4.3–10), including those with complications. Patients discharged at ≤48 h were significantly younger and had a lower incidence of multi-vessel disease than those discharged at 72 h (Abstract 9 table 1). Remaining baseline characteristics were similar. MACE at 3 years was similar between 48-h discharge patients and 72- h discharge (9.1% vs 8.7%, p=0.7). This persisted out to 5 years (9.6% vs 9%, p=0.55). As expected patients with length of stays >72 h had significantly worse outcomes (Abstract 9 figure 1).

Abstract 9 Table 1

Abstract 9 Figure 1

MACE after primary PCI.

Conclusion Early discharge at 48 h is feasible and appears to be safe for patients undergoing contemporary Primary PCI.

  • Discharge
  • STEMI
  • primary PCI

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