Safety and Cost-Effectiveness of Early Discharge After Primary Angioplasty in Low Risk Patients With Acute Myocardial Infarction 11Research funding for this study was provided by unrestricted grants from Advanced Cardiovascular Systems, Santa Clara, California; Mallinckrodt Medical, Inc., Saint Louis, Missouri; Datascope Corporation, Montvale, New Jersey; St. Jude Medical, Chelmsford, Massachusetts; and Siemens Corporation, Iselin, New Jersey.

Abstract

Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing, and a day 3 hospital discharge strategy, resulting in substantial cost savings.

Index of Microcirculatory Resistance at the Time of Primary Percutaneous Coronary Intervention Predicts Early Cardiac Complications: Insights From the OxAMI (Oxford Study in Acute Myocardial Infarction) Cohort

“…According the established cutoff values,12, 17, 18, 20 IMR >40 was measured in 102 of 261 patients (39.1%) and was able to identify all 17 patients (sensitivity: 100%) with early major cardiac complications following an acute myocardial infarction, with a specificity of 65.2% (Figure 2). The individual complications are shown in Table 2.…”

“…Current international guidelines suggest that PPCI patients with a “low‐risk of complications” might be candidates for non‐ICU admission5 and early discharge2 and mention the PAMI‐II and Zwolle scores as useful risk‐stratification tools 17, 18…”

“…This information is available at the time of completing the PPCI and may apply to ≈60% of STEMI patients, based on our cohort, and would have major implications on the ICU admission rate 31. In addition, this approach may improve patient experience32 and shorten the overall hospital stay by facilitating early discharge, with consequent reduction in hospital costs 17, 18. Furthermore, those patients with an IMR >40 represent a group at very high risk of early in‐hospital complications and may benefit from even more intensive monitoring.…”

“…According to the PAMI‐II criteria, low‐risk patients are aged <70 years with a left ventricular ejection fraction >45%, 1‐ or 2‐vessel disease, successful PCI (<50% residual stenosis and TIMI [Thrombolysis in Myocardial Infarction] flow grade ≥2 or 3), and no persistent arrhythmias 17. The Zwolle score defines STEMI patients as low risk if they have ≤3 of 16 points based on Killip class, postprocedural TIMI flow, age <60 years, ischemic time <4 hours, and absence of 3‐vessel disease or anterior myocardial infarction18 (Table S1).…”

Risk assessment in patients with ST elevation myocardial infarction treated with primary percutaneous coronary angioplasty. Does reduced duration of hospital stay affect the prognosis?

“…Identification of those patients may be facilitated by the criteria of the Primary Angioplasty in Myocardial Infarction II study (PAMI-II) or Zwolle primary percutaneous coronary intervention (PCI) index [7,8]. According to the PAMI-II criteria, the group of low-risk patients involves individuals under the age of 70 years, with LVEF over 45%, with a single-or double-vessel disease, post successful primary PCI, and with no persistent arrhythmia.…”