Patients with acute myocardial infarction who lacked early complications and independent predictors of late complications experienced a significantly lower rate of 6-month clinical events compared to high-risk patients (13.2% vs 17.6%).
Observational (n=3,739)
Yes
Does the absence of specific clinical predictors identify uncomplicated AMI patients treated with PCI who are at very low risk and suitable for early hospital discharge at day 8?
AMI patients treated with PCI who have no complications in the first 7 days and lack specific risk predictors (prior MI, LAD disease, failed PCI) are at very low risk for subsequent events and may be safely discharged at day 8.
Absolute Event Rate: 13.2% vs 17.6%
p-value: p=0.012
BACKGROUND: The hospital stay after acute myocardial infarction (AMI) is still extremely long in Japan and does not correspond with disease severity. The purpose of the present study was to identify a subgroup of AMI patients suitable for early discharge. METHODS AND RESULTS: A total of 3,739 AMI patients treated with percutaneous coronary intervention (PCI) within 24 h after onset, who enrolled Osaka Acute Coronary Insufficiency Study between April 1998 and March 2004, were studied. Patients showing no complications within the first 7 days (n=1,786) were considered to be eligible for early discharge. In these patients, multivariate logistic regression analysis selected prior myocardial infarction, left anterior descending coronary artery disease and failed PCI as independent predictors of major complications from day 8 to discharge. Patients without any predictor had significant lower rates of major complications from day 8 to 6 months after discharge than those with 1 or more predictors. Furthermore, in the present study there were no deaths in patients without any predictors. CONCLUSION: Patients who either do not have serious complications during the first 7 days or any predictor are at very low risk of major complications from day 8 to 6 months after discharge. These carefully selected patients may be suitable for early (day 8) hospital discharge after AMI.
Kinjo et al. (Sat,) conducted a observational in Acute Myocardial Infarction (n=3,739). Low-risk status (no early complications and no predictors of late complications) vs. High-risk status (1 or more predictors of late complications) was evaluated on 6-month clinical events (death, nonfatal MI, stroke, CHF, and revascularization) (p=0.012). Patients with acute myocardial infarction who lacked early complications and independent predictors of late complications experienced a significantly lower rate of 6-month clinical events compared to high-risk patients (13.2% vs 17.6%).