Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(1):61-66 | DOI: 10.5507/bp.2018.041

Safety of early discharge in low risk patients after acute ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Open label, randomized trial

Kamil Novobilskya, Roman Stipala, Petr Cernya, Ivo Horaka, Vladimir Kaucaka, Jan Mrozeka, Jan Vaclavikb, Radim Kryzaa
a Department of Cardiology, Municipal Hospital Ostrava, Nemocnicni 20, 728 80, Ostrava, Czech Republic
b Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Background: The length of hospital stay in patients with acute myocardial infarction and ST-segment elevation (STEMI) has been shortened in recent years with corresponding savings in costs, but there is limited available data on its implementation in clinical practice. The aim of this trial was to determine whether early discharge in selected patients after STEMI is feasible and safe.

Methods: 151 patients with STEMI successfully treated with primary percutaneous coronary intervention (PCI) who fulfilled the inclusion criteria of low risk were randomly assigned to two groups on a 1:1 ratio: early (within 48-72 h of admission) and standard (after 72 h) discharge. The primary end point was the composite of death, myocardial infarction (MI), unstable angina, stroke, unplanned rehospitalization, repeated target vessel revascularization and stent thrombosis at 90 days after discharge. The study is registered with ClinicalTrials.gov (identifier NCT02023983).

Results: The primary end point occurred in 5 patients in the early group and 6 in the standard group (6.6% vs. 8.0%, P=0.765). There were no significant differences in the incidence of individual components of the primary end point at 90 days. The length of hospital stay was significantly shorter in the intervention group (60.8 ± 8.5 vs. 92.1 ± 12.1 h, P<0.0001).

Conclusion: This study confirms that early discharge within 48-72 h in selected low risk patients after STEMI treated with successful primary PCI is feasible and safe, with outcomes comparable to the later discharge. This strategy applies to more than a quarter of all STEMI patients.

Keywords: ST elevation myocardial infarction, percutaneous coronary intervention, patient discharge, feasibility, safety

Received: January 8, 2018; Accepted: July 12, 2018; Prepublished online: August 28, 2018; Published: February 18, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Novobilsky, K., Stipal, R., Cerny, P., Horak, I., Kaucak, V., Mrozek, J., Vaclavik, J., & Kryza, R. (2019). Safety of early discharge in low risk patients after acute ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Open label, randomized trial. Biomedical papers, 163(1), 61-66. doi: 10.5507/bp.2018.041
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Berger AK, Duval S, Jacobs DR Jr., Barber Ch, Vazquez G, Lee S, Luepker VL. Relation of length of hospital stay in acute myocardial infarction to post-discharge mortality. Am J Cardiol 2008;101:428-34. Go to original source... Go to PubMed...
    2. Topol EJ, Burek K, O'Neill WW, Kewman DG, Kander NH, Shea MJ, Schork MA, Kirscht J, Juni JE, Pitt B. A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion. N Engl J Med 1988;318:1083-8. Go to original source... Go to PubMed...
    3. Newby LK, Eisenstein EJ, Califf RM, Thompson TD, Nelson CL, Peterson ED, Armstrong PW, Van de Werf F, White HD, Topol EJ, Mark DB. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000;342:749-55. Go to original source... Go to PubMed...
    4. Grines CL, Marsalese DL, Brodie B, Griffin J, Donohue B, Constantino CR, Balestrini C, Stone G, Wharton T, Esente P, Spain M, Moses J, Nobuyoshi M, Ayres M, Jones D, Mason D, Sachs D, Grines LI, O´Neill W. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction. J Am Coll Cardiol 1998;31:967-72. Go to original source... Go to PubMed...
    5. Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Gianuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van't Hof A, Widimsky P, Zahger D. Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2012;33:2569-619. Go to original source... Go to PubMed...
    6. Novobílský K, Kryza R, Černý P, Horák I, Kaučák V, Mrózek J, Štípal R. Early discharge (48-72 hours) after acute ST-segment elevation myocardial infarction: interim results of the open, randomized, monocentric study. The Clinician and Technology Journal 2016;46(1):55-60.
    7. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361:13-20. Go to original source... Go to PubMed...
    8. Newby LK, Califf RM, Guerci A, Weaver WD, Col J, Horgan JH, Mark DB, Stebbins A, Van de Werf F, Gore JM, Topol EJ. Early discharge in the thrombolytic era: an analysis of criteria for uncomplicated infarction from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial. J Am Coll Cardiol 1996;27:625-32. Go to original source... Go to PubMed...
    9. van der Vugt MJ, Boersma H, Leenders CM, Pop GA, Veerhoek MJ, Simoons ML, Deckers JW. Prospective study of early discharge after acute myocardial infarction (SHORT). Eur Heart J 2000;21:992-9. Go to original source... Go to PubMed...
    10. Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, Pellizzon G, O´Neill WW, Kahn JK. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI Risk Score). Am J Cardiol 2004;93:629-32. Go to original source... Go to PubMed...
    11. De Luca G, Suryapranata H, van't Hof AW, de Boer MJ, Hoorntje JC, Dambrink JH, Gosselink AT, Ottervanger JP, Zijlstra F. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004;109:2737-43. Go to original source... Go to PubMed...
    12. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, Turco M, Stuckey TD, Na Y, Lansky AJ, Gersh BJ, O'Neill WW, Mehran R, Stone GW. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol 2005;45:1397-405. Go to original source... Go to PubMed...
    13. Kotowycz MA, Cosman TL, Tartaglia C, Afzal R, Syal RP, Natarajan MK. Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction - a prospective and randomized trial in low-risk primary percutaneous coronary intervention patients (the Safe-Depart Trial). Am Heart J 2010;159(1):117.e1-6. Go to original source... Go to PubMed...
    14. Azzalini L, Solé E, Sans J, Vila M, Durán A, Gil-Alonso D, Santaló M, Garcia-Moll X, Sionis A. Feasibility and Safety of an Early Discharge Strategy after Low-Risk Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: The EDAMI Pilot Trial. Cardiology 2015;130:120-9. Go to original source... Go to PubMed...
    15. Jirmář R, Widimský P, Čapek J, Hlinomaz O, Groch L. Next day discharge after successful primary angioplasty for acute ST elevation myocardial infarction. An open randomized study ''Prague- 5''. Int Heart J 2008;49:653-9. Go to original source... Go to PubMed...
    16. Noman A, Zaman AG, Schechter C, Balasubramaniam K, Das R. Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2013;2(3):262-9. Go to original source... Go to PubMed...
    17. Melberg T, Jorgensen M, Orn S, Solli T, Edland U, Dickstein K. Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial. Eur J Prev Cardiol 2015;22(11):1427-34. Go to original source... Go to PubMed...
    18. Satilmisoglu MH, Gorgulu S, Aksu HU, Aksu H, Ertaş G, Tasbulak O, Buturak A, Kalkan AK, Degirmencioglu A, Koroglu B, Tusun E, Murat A, Oz A. Safety of Early Discharge After Primary Percutaneous Coronary Intervention. Am J Cardiol 2016;117(12):1911-6. Go to original source... Go to PubMed...
    19. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci Ch, Bueno H, Caforia ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst Ch, Vranckx P, Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39(2):119-177. doi: 10.1093/eurheartj/ehx393 Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content