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Published on: May 28, 2019
Safety of Early Discharge after Primary Angioplasty
1Department of Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan.
Insights
Early discharge after primary angioplasty for ST-elevation myocardial infarction (STEMI) is safe. This study found no increased adverse events in patients discharged in less than 48 hours compared to those discharged later.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiac event.
- Primary angioplasty (PA) is a standard treatment for STEMI.
- Assessing early discharge safety is crucial for patient management.
Purpose of the Study:
- To evaluate the safety of early discharge (less than 48 hours) for STEMI patients treated with PA.
- To compare adverse events between early and delayed discharge groups.
Main Methods:
- Observational study conducted at AFIC-NIHD from January 2017 to December 2017.
- Included STEMI patients who survived PA and were discharged home.
- Patients divided into early (<48h) and delayed (>48h) discharge groups.
- Primary outcome: all-cause mortality at 7, 30, 90, and 120 days post-discharge.
Main Results:
- 474 patients were analyzed (285 early discharge, 189 delayed discharge).
- Mean hospital stay was 64.2 hours.
- Discharge time was not significantly affected by patient demographics, comorbidities, or procedural factors.
Conclusions:
- No significant differences in adverse events were observed between early and delayed discharge groups.
- The low overall event rates in the study might contribute to these findings.
- Early discharge appears safe for selected STEMI patients post-PA.
Objective:
To assess the safety of early discharge (less than 48 hours) in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty (PA).
Study Design:
Observational study.
Place And Duration Of Study:
Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC-NIHD) From January 2017 to December 2017.
Methodology:
All STEMI patients, who underwent primary angioplasty in the above timeframe and then survived to be discharged to home, were included in the study. Patients were divided into two groups based on duration of hospital stay into early and delayed discharge groups (less or more than 48 hours, respectively). The primary outcome measure was all-cause mortality, on day-7, 30, 90, and 120-day post-discharge which was ascertained by personal or telephonic follow-up.
Results:
During the 12-month study period, 495 patients were successfully discharged to home after PA. Of these, 21 were lost to follow-up. Only the 474 cases followed-up were included in the final analysis. There were 285 patients in early discharge group, and 189 in late discharge group. The mean duration of hospital stay was 64.2 hours. In a multiple logistic regression model, the time of discharge was not affected by age, gender, diabetes mellitus, hypertension, past history of cardiac, or cerebrovascular events, Killip class at presentation, infarct location, angiographic characteristics, procedural details and complications.
Conclusion:
There were no differences between the early (<48 h) and delayed (>48 h) discharge groups in terms of adverse events. However, this might be due to an overall low event rates in the study. Key Words: ST-elevation myocardial infarction (STEMI), Primary angioplasty, Adverse event, Safety of early discharge after Primary PCI.
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