The Feasibility and Safety of Early Discharge for Low Risk Patients with Acute Myocardial Infarction after Successful Direct Percutaneous Coronary Intervention

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There is a lack of consensus among cardiologists regarding the length of time patients should be hospitalized after an uncomplicated acute myocardial infarction (AMI) and successful direct percutaneous coronary intervention (d-PCI). The purpose of this study was to evaluate the feasibility and safety of early discharge (discharge <4 days after the procedure) for low risk patients with AMI who underwent successful d-PCI. From May 1996 through December 2001, d-PCI was performed in 898 consecutive patients with AMI. Of these 898 patients, 463 (51.6%) were stratified to be at low risk. Lower risk was defined as: (1) Killip classification ≤2 on admission; (2) the infarct-related artery achieved normal blood flow without recurrent ischemia or reinfarction in the first 24 hours; (3) no mechanical or electrical complications after d-PCI, (4) no acute renal failure, acute stroke, or major bleeding complication; (5) no advanced congestive heart failure (defined as ≥New York Heart Association functional class 3); and (6) no sepsis. Patients who were discharged <4 days after undergoing the procedure were enrolled in group 1 (n=266). Patients who were discharged ≥4 days after undergoing the procedure were enrolled in group 2 (n=197). Univariate analysis demonstrated that group 2 patients had a significantly longer hospital stay (P=0.0001) than group 1 patients. At the first 30-day follow-up examination, there were no significant differences in the combined major cardiac events (death, recurrent ischemia, reinfarction, revascularization, or advanced congestive heart failure) between the group 1 and group 2 patients (1.50% vs 1.52%, P=0.92). There were also no significant differences in the combined major noncardiac complications (acute stroke, acute renal failure, bleeding complications requiring blood transfusion, vascular sequelae, or sepsis) between the group 1 and group 2 patients (1.13% vs 0.51%, P=0.89). Early discharge was feasible in a majority of the patients who experienced AMI and were at lower risk 24 hours after successful d-PCI. Thus, the patients had a shortened hospital stay and no increased risk.
Japanese Heart Journal Associationの論文

The Feasibility and Safety of Early Discharge for Low Risk Patients with Acute Myocardial Infarction after Successful Direct Percutaneous Coronary Intervention

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