Key result
Patients with STEMI and a low CADILLAC risk score had significantly fewer adverse clinical events at day 3 or later compared to those with intermediate to high risk scores (0% vs. 11.4%, P=0.0002).
Why the study?
Does the CADILLAC risk score effectively identify low-risk STEMI patients post-PCI who can be safely discharged early?
Cohort (n=228)
Does the CADILLAC risk score effectively identify low-risk STEMI patients post-PCI who can be safely discharged early?
Absolute Event Rate: 0% vs 11.4%
p-value: p=0.0002
The CADILLAC risk score effectively identifies low-risk STEMI patients post-PCI who have minimal adverse events after day 3, supporting the safety of early hospital discharge.
May support abbreviated monitoring in low-risk STEMI; hypothesis-generating and requires prospective validation.
OBJECTIVES: To examine whether the CADILLAC risk score is an effective method of patient stratification for early discharge following ST elevation myocardial infarction (STEMI). BACKGROUND: Patients with STEMI are typically hospitalized to monitor for serious complications such as arrhythmias, heart failure, and reinfarction. Optimal length of stay is unclear. Whether low risk patients can be safely discharged before 72 hr of hospitalization is unclear. METHODS: Patients with STEMI who underwent successful PCI were retrospectively stratified using CADILLAC risk score to low risk (n = 123) and intermediate to high risk (n = 105). The primary outcome was adverse clinical events at day 3 or later. Secondary outcomes were adverse clinical events on day 1 and mortality rates at 30 days and 31 to 365 days. RESULTS: Low risk patients had lower major adverse clinical events at day 3 or later (0 vs. 11.4%, P = 0.0002) and lower total mortality at 1 year (0 vs. 4.8%, P = 0.02) than patients with intermediate to high risk. Low risk patients were also less likely to have a cardiovascular event during the first 24 hr when compared to those with an intermediate to high risk score (3.3% vs. 13.3%, P = 0.006). CONCLUSION: Low risk patients identified using CADILLAC risk score with STEMI treated successfully with primary PCI have a low adverse event rate on the third day or later of hospitalization suggesting that an earlier discharge is safe in properly selected patients. Monitoring in a noncritical care setting following primary PCI for STEMI may be feasible for selected patients.
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Sharkawi et al. (2016) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=228). Low CADILLAC risk score vs. Intermediate to high CADILLAC risk score was evaluated on Adverse clinical events at day 3 or later (p=0.0002). Patients with STEMI and a low CADILLAC risk score had significantly fewer adverse clinical events at day 3 or later compared to those with intermediate to high risk scores (0% vs. 11.4%, P=0.0002).
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