Accelerated care with day 3 discharge reduced hospital costs and length of stay, with similar 6-month combined clinical events compared to traditional care (15.2% vs 17.5%, p=0.49).
RCT (n=471)
randomized
Absolute Event Rate: 15.2% vs 17.5%
p-value: p=0.49
OBJECTIVES: The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients. BACKGROUND: In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay. METHODS: Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate. Low risk patients (age 45%, one- or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing n = 237 or traditional care n = 234). RESULTS: Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4. 2+/-2. 3 vs. 7. 1+/-4. 7 days, p = 0. 0001) and had lower hospital costs (9, 658+/-5, 287 vs. 11, 604+/-6, 125 p = 0. 002) than the patients who received traditional care. At 6 months, accelerated and traditional care groups had a similar rate of mortality (0. 8% vs. 0. 4%, p = 1. 00), unstable ischemia (10. 1% vs. 12. 0%, p = 0. 52), reinfarction (0. 8% vs. 0. 4%, p = 1. 00), stroke (0. 4% vs. 2. 6%, p = 0. 07), congestive heart failure (4. 6% vs. 4. 3%, p = 0. 85) or their combined occurrence (15. 2% vs. 17. 5%, p = 0. 49). The study was designed to detect a 10% difference in event rates; at 6 months, only a 2. 3% difference was measured between groups, indicating an actual power of 0. 19. CONCLUSIONS: 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.
“For low risk patients, the total cost was $3,000 less for angioplasty than tPA.”
Grines et al. (Wed,) conducted a rct in Acute Myocardial Infarction (n=471). Accelerated care (nonintensive care unit admission and day 3 discharge without noninvasive testing) vs. Traditional care was evaluated on Combined occurrence of mortality, unstable ischemia, reinfarction, stroke, or congestive heart failure at 6 months (p=0.49). Accelerated care with day 3 discharge reduced hospital costs and length of stay, with similar 6-month combined clinical events compared to traditional care (15.2% vs 17.5%, p=0.49).