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EARLY DISCHARGE (48–72 HOURS) AFTER ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INTERIM RESULTS OF THE OPEN, RANDOMIZED, MONOCENTRIC STUDY


Authors present the interim analysis of open, prospective, randomized study, comparing the strategy of early (48–72 hours) and standard (after 72 hours) discharge in low risk patients after myocardial infarction with ST-segment elevation (STEMI), treated with successful primary percutaneous coronary intervention (PCI).

91 patients (22. 5% of all STEMI patients admitted within the period between October 15, 2013 and October 6, 2015), who fulfilled given inclusion criteria of low risk, were randomly assigned to two groups in a 1:1 ratio.

The primary end point was the composite of death, myocardial infarction (MI), unstable angina, stroke, unplanned rehospitalization, repeated target vessel revascularization, stent thrombosis within 90-day follow-up.

The length of stay was significantly shorter in the intervention group (63.0 ± 7.8 h vs. 91.1 ± 11.9 h, p < 0.0001).

The primary end point at 3 months occurred in 3 patients assigned to intervention group as compared to 2 patients assigned to control group (6.4% vs. 4.5%, p = 1.0 for non-inferiority). There were no significant differences in the incidence rates of individual components of the primary end point at 90 days.

Presented interim data of the study support the claim that early discharge (48–72 hours) in selected patients after STEMI, treated with successful primary PCI, is possible and safe, with the results comparable to the later discharge, realized in compliance with current guidelines and present everyday clinical practice.

Keywords:
myocardial infarction with ST-segment elevation, primary percutaneous coronary intervention, low risk, early discharge, feasibility, safety


Autoři: Kamil Novobílský;  Radim Kryza;  Petr Černý;  Ivo Horák;  Vladimír Kaučák;  Jan Mrózek;  Roman Štípal
Působiště autorů: Department of Cardiology, Municipal Hospital Ostrava, Czech Republic
Vyšlo v časopise: Lékař a technika - Clinician and Technology No. 2, 2016, 46, 55-60
Kategorie: Původní práce

Souhrn

Authors present the interim analysis of open, prospective, randomized study, comparing the strategy of early (48–72 hours) and standard (after 72 hours) discharge in low risk patients after myocardial infarction with ST-segment elevation (STEMI), treated with successful primary percutaneous coronary intervention (PCI).

91 patients (22. 5% of all STEMI patients admitted within the period between October 15, 2013 and October 6, 2015), who fulfilled given inclusion criteria of low risk, were randomly assigned to two groups in a 1:1 ratio.

The primary end point was the composite of death, myocardial infarction (MI), unstable angina, stroke, unplanned rehospitalization, repeated target vessel revascularization, stent thrombosis within 90-day follow-up.

The length of stay was significantly shorter in the intervention group (63.0 ± 7.8 h vs. 91.1 ± 11.9 h, p < 0.0001).

The primary end point at 3 months occurred in 3 patients assigned to intervention group as compared to 2 patients assigned to control group (6.4% vs. 4.5%, p = 1.0 for non-inferiority). There were no significant differences in the incidence rates of individual components of the primary end point at 90 days.

Presented interim data of the study support the claim that early discharge (48–72 hours) in selected patients after STEMI, treated with successful primary PCI, is possible and safe, with the results comparable to the later discharge, realized in compliance with current guidelines and present everyday clinical practice.

Keywords:
myocardial infarction with ST-segment elevation, primary percutaneous coronary intervention, low risk, early discharge, feasibility, safety


Zdroje

Berger, A.K., Duval, S., Jacobs Jr., D.R., et al. Relation of length of hospital stay in acute myocardial infarction to post-discharge mortality. American Journal of Cardiology, 2008, vol. 101, p. 428–434.

[2] Topol, E.J., Burek, K., O'Neill, W.W., et al. A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion. New England Journal of Medicine, 1988, vol. 318, p. 1083–1088.

[3] Newby, L.K., Eisenstein, E.J., Califf, R.M., et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction, New England Journal of Medicine, 2000, vol. 342, p. 749–755.

[4] Grines, C.L., Marsalese D.L., Brodie, B., et al. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction, Journal of the American College of Cardiology, 1998, vol. 31, p. 967–972.

[5] Steg, P.G., S.K. James, S.K., D. Atar, D., et al. Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology, European Heart Journal, 2012, vol. 33, p. 2569–2619.

[6] Novobílský, K., Kryza. R., Černý, P., et al. Early discharge (within 72 h) in low risk patients after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Single centre experience, Cor et Vasa, 2015, vol. 57, p. e45–e49.

[7] Newby, L.K., Califf, R.M., Guerci, A., et al. Early discharge in the thrombolytic era: an analysis of criteria for uncomplicated infarction from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial, Journal of the American College of Cardiology, 1996, vol. 27, p. 625–632.

[8] van der Vugt, M.J., Boersma, H., Leenders, C.M., et al. Prospective study of early discharge after acute myocardial infarction (SHORT), European Heart Journal, 2000, vol. 21, p. 992–999.

[9] Addala, S., Grines, S.L., Dixon, S.R., et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI Risk Score), American Journal of Cardiology, 2004, vol. 93, p. 629–632.

[10] De Luca, G., H. Suryapranata, H., A.W. van't Hof, A.W., et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge, Circulation, 2004, vol. 109, p. 2737–2743.

[11] Halkin, A., Singh, M., Nikolsky, E., et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score, Journal of the American College of Cardiology, 2005, vol. 45, p. 1397–1405.

[12] Kotowycz, M.A., Cosman, T.L., Tartaglia, C., et al. Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction – a prospective and randomized trial in low-risk primary percutaneous coronary intervention patients (the Safe-Depart Trial), American Heart Journal, 2010, vol. 159, p. 117.e1–117.e6.

[13] Noman, A., Zaman, A.G., Schechter, C., et al. Early discharge after primary percutaneous coronary intervene-tion for ST-elevation myocardial infarction, European Heart Journal: Acute Cardiovascular Care, 2013, vol. 2, p. 262–269.

[14] Azzalini, L., Solé, E., Sans, J., et al. Feasibility and Safety of an Early Discharge Strategy after Low-Risk Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: The EDAMI Pilot Trial, Cardiology, 2015, vol. 130, p. 120–129.

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