Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Patient Selection
2.3. Endpoints
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Early Discharge N = 453 | ||
---|---|---|
Variable | Age, years | 62.4 ± 12.5 |
Age ≥ 65 | 164 (36.2%) | |
Female gender | 110 (24.3%) | |
Inclusion period | ≤2017 | 115 (25.4%) |
>2017 | 338 (74.6%) | |
Smoking status | Current smokers | 188 (41.5%) |
Former smokers | 79 (17.4%) | |
Past medical history | Dyslipidemia | 226 (49.9%) |
Hypertension | 217 (47.9%) | |
Diabetes Mellitus | 81 (17.9%) | |
Atrial fibrillation | 20 (4.4%) | |
Heart failure | 5 (1.1%) | |
Previous MI | 71 (15.7%) | |
Previous PCI | 84 (18.5%) | |
Previous stroke | 13 (2.9%) | |
COPD | 12 (2.7%) | |
Hospital stay | Length, days | 1.74 |
Discharge before 24 h | 84 (18.5%) | |
Revascularization | No revascularization | 15 (3.3%) |
Complete revascularization | 383 (84.5%) | |
Incomplete revascularization | 55 (12.2%) | |
Culprit vessel | None | 8 (1.8%) |
RCA | 205 (45.2%) | |
LAD | 162 (35.8%) | |
LCx | 77 (17%) | |
LMCA | 2 (0.5%) | |
Multivessel revascularization | Single Stage | 44 (9.7%) |
Two-Stage | 12 (2.7%) | |
Number of stents used | None | 15 (3.3%) |
One | 309 (68.2%) | |
Two | 99 (21.9%) | |
Three | 29 (6.4%) | |
Four | 1 (0.2%) | |
LVEF at discharge | ≥50% | 380 (83.9%) |
41–49% | 58 (12.8%) | |
≤40% | 15 (3.3%) | |
P2Y12 Inhibitor | Prasugrel | 262 (57.8%) |
Ticagrelor | 124 (27.4%) | |
Clopidogrel | 52 (11.5%) |
Early Discharge N Total = 453 Patients | |
---|---|
Primary Endpoint (non-fatal stroke, non-fatal MI, CV death) | 1 (0.2%) |
Secondary endpoints | |
All-cause mortality | 0 (0%) |
Non-fatal MI | 1 (0.2%) |
CV death | 0 (0%) |
Re-hospitalization or ED visit Due to CV causes | 5 (1.1%) |
Patient | Age (Years) | Gender | LVEF | Culprit Vessel | Recurrent Symptom in ED Visit |
---|---|---|---|---|---|
1 | 48 | Male | >55% | RCA | Angina. Repeated catheterization: non-obstructive coronary arteries. Positive Acetylcholine test. |
2 | 63 | Male | >55% | RCA | Chest pain. Repeated catheterization: non-obstructive coronary arteries. |
3 | 69 | Female | >55% | RCA | Atrial fibrillation. No readmission required |
4 | 83 | Male | 45% | LAD | Atrial fibrillation. No readmission required. |
5 | 82 | Female | 40% | LAD | Acute thrombotic stent occlusion 30 days after primary PCI. Required repeated PCI and readmission with no further adverse events. |
Score | Low-Risk Criteria | Reference |
---|---|---|
PAMI-II | Age < 70 years, LVEF > 45%, one- or two-vessel disease undergoing successful PCI with no persistent arrhythmias | [5,12] |
Zwolle risk score ≥ 3 | A risk score based on Killip class, TIMI grade flow, age, presence of three-vessel disease, anterior infarction, ischemia time < or >4 h | [8,9] |
Yndigegn T et al. | Age < 70 years, one- or two-vessel disease, LVEF ≥ 50%, absence of serious arrhythmias requiring defibrillation/cardioversion or pacemaker | [12] |
Rathod KS et al. | LVEF ≥ 40%, successful primary PCI, absence of bystander disease requiring inpatient revascularization, no recurrence of ischemic symptoms, Killip I, no significant arrhythmias, mobility with suitable social circumstances for discharge | [13] |
Bawamia et al. | Successful primary PCI, absence of a severe bystander disease requiring inpatient revascularization, non-anterior infarction, absence of hemodynamic instability, arrhythmias, heart failure, severe comorbidities and suitable social support | [14] |
CADILLAC 0–2 | LVEF < 40%, Creatinine clearance < 60 mL/min, Killip class II/III, Final TIMI flow 0–2, Age > 65 years, anemia, three-vessel disease | [15] |
Current study * | Successful primary PCI, LVEF ≥ 40%, absence of vascular or cardiac complications, functionally complete revascularization. | - |
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Piris, A.; Garcia-Linacero, L.M.; Ortega-Perez, R.; Rivas-Garcia, S.; Martinez-Moya, R.; Sanmartin, M.; Zamorano, J.L. Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction. J. Clin. Med. 2024, 13, 3827. https://doi.org/10.3390/jcm13133827
Piris A, Garcia-Linacero LM, Ortega-Perez R, Rivas-Garcia S, Martinez-Moya R, Sanmartin M, Zamorano JL. Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction. Journal of Clinical Medicine. 2024; 13(13):3827. https://doi.org/10.3390/jcm13133827
Chicago/Turabian StylePiris, Antonio, Luis Manuel Garcia-Linacero, Rodrigo Ortega-Perez, Sonia Rivas-Garcia, Rafael Martinez-Moya, Marcelo Sanmartin, and Jose Luis Zamorano. 2024. "Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction" Journal of Clinical Medicine 13, no. 13: 3827. https://doi.org/10.3390/jcm13133827
APA StylePiris, A., Garcia-Linacero, L. M., Ortega-Perez, R., Rivas-Garcia, S., Martinez-Moya, R., Sanmartin, M., & Zamorano, J. L. (2024). Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction. Journal of Clinical Medicine, 13(13), 3827. https://doi.org/10.3390/jcm13133827