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.
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.
Effect estimate: c statistic 0.907
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.
Luca et al. (Tue,) 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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