Key result
Early discharge (48-72 hours) in low-risk patients with uncomplicated acute myocardial infarction resulted in a 6-month major adverse event rate of 2%, compared to 1.5% with standard discharge.
Why the study?
Does early discharge (48-72 hours) maintain safety compared to standard discharge (>7 days) in low-risk patients with uncomplicated acute myocardial infarction?
Cohort (n=389)
No
Does early discharge (48-72 hours) maintain safety compared to standard discharge (>7 days) in low-risk patients with uncomplicated acute myocardial infarction?
Absolute Event Rate: 2% vs 1.5%
Early discharge (48-72 hours) appears safe for low-risk patients with uncomplicated acute myocardial infarction treated with successful PCI, showing no significant difference in 6-month adverse events compared to standard discharge.
Supports safety of early discharge in low-risk AMI; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Acute myocardial infarction (AMI) management aims to ensure the best care for patients while reducing hospital stay. The aim of this study was to evaluate feasibility and safety of early discharge (defined as discharge between 48 and 72 h from AMI) in low-risk patients after uncomplicated infarction. METHODS: We prospectively evaluated 321 patients (age: 59 +/- 11.7), who were admitted for AMI between February 2004 and August 2005 and assigned to 'low'-risk and 'high'-risk groups according to clinical and angiographic criteria. Low-risk patients were discharged between 48 and 72 h from admission. After discharge, all patients were re-evaluated after 1 week, 6 weeks and 6 months for AMI. We also retrospectively considered a control group of 68 low-risk patients with AMI admitted to our Coronary Intensive Care Unit (CICU) in the previous 4 months before the beginning of the study with standard discharge after at least 7 days of hospital stay. RESULTS: No events were detected in the first week after discharge. In low-risk patients, the cumulative major adverse event rate was 0.6% after 6 weeks, whereas in high-risk patients, the rate was 9% (P < or = 0.01). After 6 months, in the low-risk group, the cumulative major adverse event rate was 2%, whereas in the high-risk group, it was 10% (P < or = 0.01). The control group showed a cumulative major adverse event rate of 1.5% after 6 months, with no statistically significant difference between controls and low-risk patients. The type of AMI did not influence risk assessment and clinical outcome. CONCLUSION: Our data support the short-term safety and cost-effectiveness of early discharge in patients with uncomplicated AMI, treated with successful percutaneous coronary intervention.
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Branca et al. (2008) conducted a cohort in Acute myocardial infarction (n=389). Early discharge (48-72 hours) vs. Standard discharge (≥7 days) was evaluated on Cumulative major adverse events at 6 months. Early discharge (48-72 hours) in low-risk patients with uncomplicated acute myocardial infarction resulted in a 6-month major adverse event rate of 2%, compared to 1.5% with standard discharge.
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