TY - JOUR
T1 - Safety of early hospital discharge following admission with ST-elevation myocardial infarction treated with percutaneous coronary intervention
T2 - A nationwide cohort study
AU - Yndigegn, Troels
AU - Gilje, Patrik
AU - Dankiewicz, Josef
AU - Mokhtari, Arash
AU - Isma, Nazim
AU - Holmqvist, Jasminka
AU - Schiopu, Alexandru
AU - Ravn-Fischer, Annika
AU - Hofmann, Robin
AU - Szummer, Karolina
AU - Jernberg, Tomas
AU - James, Stefan
AU - Gale, Chris P.
AU - Frobert, Ole
AU - Mohammad, Moman A.
N1 - Publisher Copyright:
© 2022 The authors.
PY - 2022/1
Y1 - 2022/1
N2 - Background: 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. Aims: We aimed to assess the safety of early discharge (≤2 days) for low-risk STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: Using nationwide data from the SWEDEHEART registry, we identified patients with STEMI treated with primary PCI during the period 2009-2017, of whom 8,092 (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 primary endpoint was major adverse cardiovascular events (MACE, including death, reinfarction treated with PCI, stroke or heart failure hospitalisation) at one year, assessed using a Cox proportional hazards model with propensity score as well as an inverse probability weighting propensity score of average treatment effect to adjust for confounders. Results: A total of 1,449 (17.9%) patients were discharged ≤2 days from admission. After adjustment, the one-year MACE rate was not higher for patients discharged at >2 days from admission than for patients discharged ≤2 days (4.3% vs 3.2%; adjusted HR 1.31, 95% confidence interval [CI]: 0.92-1.87, p=0.14), and no difference was 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. Conclusions: Nationwide observational data suggest that early discharge of low-risk patients with STEMI treated with PCI is not associated with an increase in one-year MACE.
AB - Background: 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. Aims: We aimed to assess the safety of early discharge (≤2 days) for low-risk STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: Using nationwide data from the SWEDEHEART registry, we identified patients with STEMI treated with primary PCI during the period 2009-2017, of whom 8,092 (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 primary endpoint was major adverse cardiovascular events (MACE, including death, reinfarction treated with PCI, stroke or heart failure hospitalisation) at one year, assessed using a Cox proportional hazards model with propensity score as well as an inverse probability weighting propensity score of average treatment effect to adjust for confounders. Results: A total of 1,449 (17.9%) patients were discharged ≤2 days from admission. After adjustment, the one-year MACE rate was not higher for patients discharged at >2 days from admission than for patients discharged ≤2 days (4.3% vs 3.2%; adjusted HR 1.31, 95% confidence interval [CI]: 0.92-1.87, p=0.14), and no difference was 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. Conclusions: Nationwide observational data suggest that early discharge of low-risk patients with STEMI treated with PCI is not associated with an increase in one-year MACE.
KW - Early discharge
KW - Length of hospital stay PAMI-II
KW - STEMI
UR - http://www.scopus.com/inward/record.url?scp=85123879447&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-21-00501
DO - 10.4244/EIJ-D-21-00501
M3 - Journal article
C2 - 34338642
AN - SCOPUS:85123879447
SN - 1774-024X
VL - 17
SP - 1091
EP - 1099
JO - EuroIntervention
JF - EuroIntervention
IS - 13
ER -