The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
Safety of Early Hospital Discharge Following Admission with ST-Elevation Myocardial Infarction treated with Percutaneous Coronary Intervention: A Nationwide Cohort Study
Troels Yndigegn1; Patrick Gilje1; Josef Dankiewicz1; Arash Mokhtari1; Nazim Isma1; Jasminka Holmqvist1; Alexandru Schiopu2; Annika Ravn-Fischer3; Robin Hofmann4; Karolina Szummer5; Tomas Jernberg6; Stefan James7; Chris P. Gale8; Ole Fröbert9; Moman A. Mohammad1;
1. Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden, Sweden 2. Department of Internal Medicine, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden 3. Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden 4. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. 5. Department of Medicine (Huddinge), Karolinska Institutet; Department of Cardiology, Karolinska 6. Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden 7. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden 8. Leeds Institute of Cardiovascular and Medicine, University of Leeds, Leeds, UK; Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK 9. Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
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The Second Primary Angioplasty in Myocardial Infarction (PAMI-II) risk score is recommended by guidelines to identify low-risk patients with ST-elevation myocardial infarction (STEMI) for an early discharge strategy.
We aimed to assess the safety of early discharge (≤2 days) for low-risk STEMI treated with primary percutaneous coronary intervention (PCI).
Using nationwide data from the SWEDEHEART registry we identified patients with STEMI treated with primary PCI during 2009-2017 of whom 8092 (26.4%) were identified as low risk with the PAMI-II score. Low risk patients were stratified according to their length of hospital stay (≤2 days vs. >2 days) The main endpoint was major adverse cardiovascular events (MACE) including death, reinfarction treated with PCI, stroke or heart failure hospitalization) at one year using a Cox proportional hazard model with propensity score as well as an inverse probability weighting propensity score of average treatment effect to adjust for confounders.
There were 1449 (17.9%) patients discharged ≤2 days of admission. After adjustment, the 1-year MACE rate were not higher for patients discharged at >2 days from admission than patients discharged ≤2 days (4.3% vs. 3.2%; adjusted HR, 1.31 [95% CI, 0.92–1.87, p=0.14]) and no difference were observed regarding any of the individual components of the main outcome. Results were consistent across all subgroups with no difference in MACE between early and late discharge patients.
Nationwide observational data suggests that early discharge of low-risk patients with STEMI treated with PCI is not associated with an increase in 1-year MACE.