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How long should patients with suspected myocardial infarction be under observation in hospital?
Insights
Patients with chest pain can be safely discharged within 24 hours, even if acute myocardial infarction is not fully excluded. Conventional tests are sufficient for this decision, improving hospital resource use.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Chest pain is a common reason for hospital admission, often raising concern for acute myocardial infarction (AMI).
- Early and accurate risk stratification is crucial for efficient patient management and resource allocation.
Purpose of the Study:
- To evaluate the safety and efficacy of early hospital discharge for patients presenting with chest pain and suspected AMI.
- To determine if conventional diagnostic tests are adequate for decision-making within 24 hours of admission.
Main Methods:
- Retrospective analysis of 368 patients admitted for chest pain and suspected AMI.
- Discharge decisions within 24 hours based on clinical assessment, ECG, and cardiac enzyme levels (AST, LDH, CPK).
- 28-day follow-up for readmissions and adverse cardiac events.
Main Results:
- 267 out of 368 patients were discharged within 24 hours.
- 17 patients were readmitted within 28 days; two with non-fatal AMI, and two died.
- Adverse event rates were similar between groups with presumed non-coronary and coronary chest pain.
Conclusions:
- Early discharge (within 24 hours) is feasible for selected chest pain patients, even without definitively ruling out AMI.
- Standard clinical evaluation, ECG, and cardiac biomarkers are sufficient for safe discharge decisions.
- This approach can optimize hospital bed utilization for acute chest pain presentations.
Abstract:
Out of 368 patients admitted to hospital for chest pain and suspected acute myocardial infarction, 267 were discharged within 24 hours on the basis of the clinical picture, electrocardiogram, and serum activities of aspartate transaminase, alpha-hydroxybutyrate dehydrogenase, and creatine phosphokinase. The patients were followed up for 28 days, during which 17 were readmitted, two of them twice and one three times. Two of the patients were readmitted with non-fatal acute myocardial infarction, and two died. The patients had been primarily divided into two groups: those admitted with presumably non-coronary chest pain (77 patients) formed group 1 and those with obvious coronary chest pain (190 patients) group 2. Both deaths occurred in patients in group 2 but the incidences of events during the follow-up period were otherwise similar in the two groups, and some patients in both groups may have had small acute myocardial infarctions when first admitted. The decision to keep in hospital or discharge a patient with chest pain of recent onset can be made within 24 hours of admission. To discharge the patient acute myocardial infarction need not necessarily be excluded and conventional tests are enough to enable a decision to be made.