Early discharge (within 72 h) in low risk patients after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Single centre experience

Novobílský, Kamil; Kryza, Radim; Černý, Petr; Kaučák, Vladimír; Mrózek, Jan; Horák, Ivo

doi:10.1016/j.crvasa.2014.10.001

Cited by 3 publications

(7 citation statements)

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“…tested safety hypothesis of discharge within 48 to 56 hours as opposed to usual discharge, and reported no difference in all-cause mortality (0.6% vs. 0.8%; p = 0.369) and readmission (3.8% vs. 6.9%; p = 0.061) rate after 30-days of discharge respectively. Similarly, many other studies conducted in various parts of the world showed evidence in favor of the early discharge (≤ 72 hours) strategy [11][12][13][14]23]. However, evidence regarding safety of same day (≤ 24 hours) discharge strategy in setting of primary PCI is very limited as safety of this strategy after successful ad hoc or elective PCI has been reported by only a few studies [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the advancements in the management strategies and use of evidence based pharmacological therapies, there is a growing trend of reduced hospital stay for STEMI patients [ 9 10 ]. Feasibility, safety, and cost-effectiveness of the reduction of post-procedure hospital stay in selected low-risk STEMI patients has been demonstrated by some of the recent studies [ 11 12 13 14 ]. Randomized studies conducted thus far have established safety and feasibility of ≤ 72 hours post-procedure discharge strategy [ 11 14 15 16 17 ] and 48 to 56 hours post-procedure discharge strategy [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Feasibility, safety, and cost-effectiveness of the reduction of post-procedure hospital stay in selected low-risk STEMI patients has been demonstrated by some of the recent studies [ 11 12 13 14 ]. Randomized studies conducted thus far have established safety and feasibility of ≤ 72 hours post-procedure discharge strategy [ 11 14 15 16 17 ] and 48 to 56 hours post-procedure discharge strategy [ 18 ]. However, evidence from clinical trials with regards to next day discharge strategy (≤ 24 hour of procedure) is lacking; the only evidence of feasibility for next day discharge strategy from the Prague-5 trial is limited to a very limited number of patients [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

et al. 2021

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Background:The strategy for early discharge after primary percutaneous coronary intervention (PCI) could have substantial financial benefits, especially in low-middle income countries. However, there is a lack of local evidence on feasibility and safety of the strategy for early discharge. Therefore, the aim of this study was to assess the safety of early discharge after primary PCI in selected low-risk patients in the population of Karachi, Pakistan. Methods: In this study 600 consecutive low-risk patients who were discharged within 48 hours of primary PCI were put under observation for major adverse cardiac events (MACE) after 7 and 30 days of discharge respectively. Patients were further stratified into discharge groups of very early (≤ 24 hours) and early (24 to 48 hours). Results: The sample consisted of 81.8% (491) male patients with mean age of 54.89 ± 11.08 years. Killip class was I in 90% (540) of the patients. The majority of patients (84%) were discharged within 24 hours of the procedure. Loss to follow-up after rate at 7 and 30 days was 4% (24) and 4.3% (26) respectively. Cumulative MACE rate after 7 and 30 days was observed in 3.5% and 4.9%, all-cause mortality in 1.4% and 2.3%, cerebrovascular events in 0.9% and 1.4%, unplanned revascularization in 0.9% and 1.2%, re-infarction in 0.3% and 0.5%, unplanned re-hospitalization in 0.5% and 0.5%, and bleeding events in 0.5% and 0.5% of the patients respectively. Conclusion:It was observed that very early (≤ 24 hours) discharge after primary PCI for lowrisk patients is a safe strategy subjected to careful pre-discharge risk assessment with minimal rate of MACE after 7-days as well as 30-days.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

et al. 2021

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“…Benha University, Benha, Egypt. 2 King Abdullah Medical City, Muzdallfa Road, Makkah, Saudi Arabia. 3 Zagazig University, Zagazig, Egypt.…”

Section: Fundingmentioning

confidence: 99%

“…Shortening of the hospital stay in patients admitted with the diagnosis of acute myocardial infarction (AMI) has been observed within the last decades [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Early discharge (within 24–72 h) in low-risk AMI patients treated with PCI: feasibility and safety—Hajj study

et al. 2020

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Background Shortening of the hospital stay in patients admitted with the diagnosis of acute myocardial infarction (AMI) has been observed within the last decades. Our center is the only cardiac center in the region providing tertiary care facility and hence receives all AMI patients deemed suitable for invasive assessment and management and this leads to huge required demand. Our aim is to assess feasibility and safety of the early discharge of selected proportion of AMI patients. Result Out of 557 of patients presented with AMI and treated with percutaneous coronary intervention (PCI), 310 (56%) were discharged early. Men patients and pilgrims were more prevalent among the early discharge group. Early discharged patients had significantly less comorbidities compared to the other group of patients. Moreover, they presented mainly with ST-elevation myocardial infarction (P = 0.04) and treated more with primary percutaneous coronary intervention (PPCI) (P = 0.04). They had favorable coronary anatomy (P = 0.01 and 0.02 for left main and multi-vessel coronary artery disease, respectively), better hospital course, and higher left ventricular ejection fraction compared to non-early discharged patients (P = 0.006 and < 0.001 for pulmonary edema and left ventricular ejection fraction post myocardial infarction). Follow-up of those early discharged patients were promising as majority of them were asymptomatic (95%) and did well post-discharge. Conclusion Our study demonstrated data that support safety of early discharge in a carefully selected group of AMI patients. Early but safe discharge may have a huge impact on increasing bed availability, reducing hospital costs, and improving patient’s satisfaction.

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Zwolle Risk Score for Safety Assessment of Same-Day Discharge after Primary Percutaneous Coronary Intervention

Shah¹,

Solangi²,

Batra³

et al. 2021

Journal of the Saudi Heart Association

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Objectives The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 h (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; low-risk (≤3) and high-risk (≥4). All patients were followed during 30-days post-procedure period for major adverse cardiac events (MACE). Results Out of 487 patients, 83.2% (405) were male and mean age was 54.6 ± 10.87 years. Mean ZRS was 2.34 ± 1.64 with 16.0% (78) patients in high-risk (≥4) group. 30-days MACE rate was observed to be 5.3% (26) with significantly higher rate among high-risk patients as compared to low-risk patients 12.8% (10) vs. 3.9% (16); p = 0.004 respectively with OR of 3.61 [1.57–8.29]. The area under the curve (AUC) of ZRS for prediction of 30-day MACE was 0.67 [95% CI: 0.58–0.77], ZRS ≥4 had sensitivity of 38.5% and specificity of 85.2% with AUC of 0.62 [95% CI: 0.50–0.74] for prediction of 30-day MACE. Conclusion ZRS showed moderate discriminating potential in identifying patients with high-risk of MACE at 30-day after same-day discharge after primary PCI.

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Early discharge (within 72 h) in low risk patients after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Single centre experience

Cited by 3 publications

References 15 publications

Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

Early discharge (within 24–72 h) in low-risk AMI patients treated with PCI: feasibility and safety—Hajj study

Zwolle Risk Score for Safety Assessment of Same-Day Discharge after Primary Percutaneous Coronary Intervention

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