Identifying patients for safe early hospital discharge following st elevation myocardial infarction
Musa A Sharkawi1,2, Andreas Filippaios3, Saurabh S Dani4
1Department of Cardiovascular Medicine, Hartford Hospital, Hartford, Connecticut.
Insights
The CADILLAC risk score effectively identifies low-risk patients with ST-elevation myocardial infarction (STEMI) for safe early discharge. This stratification minimizes adverse events and mortality, making earlier hospital release feasible for selected individuals post-PCI.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Acute Coronary Syndromes
Background:
- Hospitalization for ST-elevation myocardial infarction (STEMI) is standard for monitoring complications.
- The optimal duration of hospital stay post-STEMI remains unclear.
- The safety of early discharge (before 72 hours) for low-risk STEMI patients is not well-established.
Purpose of the Study:
- To evaluate the effectiveness of the CADILLAC risk score in stratifying patients with STEMI for early discharge.
- To determine if low-risk stratification by CADILLAC score predicts favorable outcomes.
- To assess the safety and feasibility of early discharge for selected STEMI patients post-primary PCI.
Main Methods:
- Retrospective analysis of STEMI patients who underwent successful percutaneous coronary intervention (PCI).
- Stratification of patients into low-risk (n=123) and intermediate-to-high-risk (n=105) groups using the CADILLAC risk score.
- Primary outcome: adverse clinical events from day 3 onwards. Secondary outcomes: early adverse events (day 1) and mortality at 30 days and 1 year.
Main Results:
- Low-risk patients experienced significantly fewer major adverse clinical events at day 3 or later (0% vs. 11.4%, P=0.0002).
- One-year mortality was substantially lower in the low-risk group (0% vs. 4.8%, P=0.02).
- Low-risk patients had fewer cardiovascular events within the first 24 hours (3.3% vs. 13.3%, P=0.006).
Conclusions:
- The CADILLAC risk score is effective for identifying low-risk STEMI patients suitable for early discharge after successful primary PCI.
- Early discharge appears safe for selected low-risk STEMI patients, with significantly reduced adverse events.
- Non-critical care monitoring may be a feasible option for these selected patients post-primary PCI.
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. © 2016 Wiley Periodicals, Inc.
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