Key result
Early discharge within two days for low-risk STEMI PCI is not linked to higher MACE.
Why the study?
Guidelines recommend the PAMI-II risk score to identify low-risk STEMI patients for early discharge, but the safety of early discharge (≤2 days) following primary PCI required evaluation.
Does early hospital discharge (≤2 days) increase the risk of major adverse cardiovascular events in low-risk STEMI patients treated with primary PCI?
Cohort (n=8,092)
Yes
Does early hospital discharge (≤2 days) increase the risk of major adverse cardiovascular events in low-risk STEMI patients treated with primary PCI?
Effect estimate: HR 1.31 (95% CI 0.92-1.87)
Absolute Event Rate: 3.2% vs 4.3%
p-value: p=0.14
Early hospital discharge (≤2 days) for low-risk STEMI patients treated with primary PCI is safe and not associated with an increased risk of major adverse cardiovascular events at one year.
Supports early discharge feasibility in PAMI-II low-risk STEMI; extends observational data but leaves open need for randomized confirmation.
BACKGROUND: The Second Primary Angioplasty in Myocardial Infarction (PAMI-II) risk score is recommended by guidelines to identify low-risk patients with ST-elevation myocardial infarction (STEMI) for an early discharge strategy. AIMS: We aimed to assess the safety of early discharge (≤2 days) for low-risk STEMI patients treated with primary percutaneous coronary intervention (PCI). METHODS: Using nationwide data from the SWEDEHEART registry, we identified patients with STEMI treated with primary PCI during the period 2009-2017, of whom 8,092 (26.4%) were identified as low risk with the PAMI-II score. Low-risk patients were stratified according to their length of hospital stay (≤2 days vs >2 days). The primary endpoint was major adverse cardiovascular events (MACE, including death, reinfarction treated with PCI, stroke or heart failure hospitalisation) at one year, assessed using a Cox proportional hazards model with propensity score as well as an inverse probability weighting propensity score of average treatment effect to adjust for confounders. RESULTS: A total of 1,449 (17.9%) patients were discharged ≤2 days from admission. After adjustment, the one-year MACE rate was not higher for patients discharged at >2 days from admission than for patients discharged ≤2 days (4.3% vs 3.2%; adjusted HR 1.31, 95% confidence interval [CI]: 0.92-1.87, p=0.14), and no difference was observed regarding any of the individual components of the main outcome. Results were consistent across all subgroups with no difference in MACE between early and late discharge patients. CONCLUSIONS: Nationwide observational data suggest that early discharge of low-risk patients with STEMI treated with PCI is not associated with an increase in one-year MACE.
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Yndigegn et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=8,092). Early discharge (≤2 days from admission) vs. Late discharge (>2 days from admission) was evaluated on Major adverse cardiovascular events (MACE) at one year (HR 1.31, 95% CI 0.92-1.87, p=0.14).
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