Key result
A prognostic score identified 73.4% of STEMI patients treated with primary angioplasty as low risk (c-statistic=0.907), who had a 0.2% mortality rate between 2 and 10 days.
Why the study?
Does early discharge guided by a prognostic score safely reduce costs compared to conventional care in low-risk STEMI patients treated with primary angioplasty?
Cohort (n=1,791)
Does early discharge guided by a prognostic score safely reduce costs compared to conventional care in low-risk STEMI patients treated with primary angioplasty?
A novel prognostic score can reliably identify a large cohort of low-risk STEMI patients after primary angioplasty who may safely be discharged early, potentially saving significant costs.
Answers are grounded in this paper and cite their sources.
May support early discharge decisions after primary angioplasty in low-risk STEMI; leaves open randomized confirmation of safety and cost savings.
BACKGROUND: The aim of this study was to create a practical score for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty and to assess the feasibility of early discharge in low-risk patients. METHODS AND RESULTS: A prognostic score was built according to 30-day mortality rates in 1791 patients undergoing primary angioplasty for STEMI. For the identified low-risk patients without any contraindication to early discharge, we estimated and compared the costs of conventional care (prolonged 24-hour hospitalization) with the costs of shifting the care from inpatient to outpatient setting (early discharge) between 48 and 72 hours. Independent predictors of 30-day mortality included in the score were age, anterior infarction, Killip class, ischemic time, postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow, and multivessel disease. This score was able to identify a large cohort (73.4%) of low-risk (score < or =3) patients, with a good discriminatory capacity (c statistic=0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score < or =3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at 1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of 194 933.33, in comparison with an early discharge policy. CONCLUSIONS: This score is a practical and useful index for risk stratification after primary angioplasty for STEMI, with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.
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Luca et al. (2004) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,791). Prognostic score for risk stratification vs. Conventional care was evaluated on 30-day mortality (c statistic 0.907). A prognostic score identified 73.4% of STEMI patients treated with primary angioplasty as low risk (c-statistic=0.907), who had a 0.2% mortality rate between 2 and 10 days.
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