Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction
- Daniel A Jones1,2,3,
- Krishnaraj S Rathod1,
- James Philip Howard1,
- Sean Gallagher1,3,
- Sotiris Antoniou1,
- Rodney De Palma1,3,
- Oliver Guttmann1,
- Samantha Cliffe1,
- Judith Colley1,
- Jane Butler1,
- Eileen Ferguson1,3,
- Saidi Mohiddin1,2,3,
- Akhil Kapur1,3,
- Charles J Knight1,3,
- Ajay K Jain1,3,
- Martin T Rothman1,3,
- Anthony Mathur1,2,3,
- Adam D Timmis1,2,3,
- Elliot J Smith1,3,
- Andrew Wragg1,2,3
- 1Department of Cardiology, Barts and the London NHS Trust, London, UK
- 2Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
- 3NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
- Correspondence to Dr Andrew Wragg, Department of Cardiology, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, UK; andrew.wragg{at}bartsandthelondon.nhs.uk
- Accepted 3 September 2012
- Published Online First 10 October 2012
Abstract
Aim Primary percutaneous coronary intervention (PPCI) produces more effective coronary reperfusion and allows immediate risk stratification compared with fibrinolysis. We investigated the safety and feasibility of very early discharge at 2 days following PPCI in selected low-risk cases.
Methods This was a prospective observational cohort study of 2779 patients who underwent PPCI between 2004 and 2011. Patients meeting the following criteria were deemed suitable for very early discharge; TIMI III flow, left ventricle (LF) ejection fraction >40%, and rhythmic and haemodynamic stability out to 48 h. Higher-risk patients who did not fulfil these criteria were discharged later according to physician preference. All patients were offered outpatient review by a multidisciplinary team. Endpoints included 30 day readmission rates and major adverse cardiac events (MACE) out to a median of 2.8 years (IQR range: 1.3–4.4 years).
Results 1309 (49.3%) PPCI patients met very early discharge criteria, of whom 1117 (85.3%) were actually discharged at 2 days. 620 (23.4%) were discharged at 3 days, and 916 (34.5%) >3 days after admission (median 5, IQR: 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, compared with patients discharged later. 30-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. MACE rates were lowest in patients discharged at 2 days (9.6%, 95% CI 4.7% to 16.6%) compared with patients discharged at 3 days (12.3% 95% CI 6.0% to 19.2%) and >3 days (28.6% 95% CI 22.9% to 34.7%, p<0.0001) after admission.
Conclusions Our data suggest that discharge of low-risk patients 2 days after successful PPCI is feasible and safe. Over 40% of all patients with ST-elevation myocardial infarction may be suitable for early discharge with important implications for healthcare costs.
