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Early vs Late Discharge in Low-Risk ST-Elevation Myocardial Infarction Patients Treated With Percutaneous Coronary

Zain Ul Abideen Asad1, Safi U Khan2, Amod Amritphale1

  • 1Department of Medicine, Section of Cardiovascular Disease, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|June 1, 2020
PubMed

Insights

Early discharge after percutaneous coronary intervention for ST-elevation myocardial infarction is safe for low-risk patients. This strategy may reduce mortality and major adverse cardiac events, improving care costs.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Guidelines for optimal discharge timing after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) are inconsistent.
  • European Society of Cardiology guidelines suggest early discharge (48-72 hours), while American College of Cardiology guidelines lack specific recommendations.

Purpose of the Study:

  • To compare outcomes of early discharge (≤3 days) versus late discharge (>3 days) in low-risk STEMI patients undergoing PCI.
  • To evaluate the safety and efficacy of early discharge strategies.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
  • Searched MEDLINE and EMBASE databases.
  • Outcomes analyzed using random effects risk ratios (RR) with 95% confidence intervals, stratified by study design.

Main Results:

  • RCT analysis (1780 patients) showed no significant differences in all-cause mortality or major adverse cardiac events (MACE) between early and late discharge.
  • Observational study analysis (39,288 patients) indicated early discharge was associated with reduced all-cause mortality (RR, 0.40) and MACE (RR, 0.45).
  • No significant differences in hospital readmissions were observed between early and late discharge groups in either analysis.

Conclusions:

  • Early discharge is safe for selected low-risk STEMI patients undergoing PCI.
  • An early discharge strategy has the potential to improve the cost-effectiveness of patient care.
  • Further research may clarify optimal discharge criteria for this patient population.
Abstract

Keywords:
Length of stayMeta-analysisST-elevation myocardial infarction

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