Early Hospital Discharge Following PCI for Patients With STEMI
Krishnaraj S Rathod, Katrina Comer, Oliver Casey-Gillman, Lizzie Moore, Gordon Mills, Gordon Ferguson, Sotiris Antoniou, Riyaz Patel, Sadeer Fhadil, Tasleem Damani, Paul Wright, Mick Ozkor, Debashish Das, Oliver P Guttmann, Andreas Baumbach, R Andrew Archbold, Andrew Wragg, Ajay K Jain, Fizzah A Choudry, Anthony Mathur, Daniel A Jones, Krishnaraj S Rathod, Katrina Comer, Oliver Casey-Gillman, Lizzie Moore, Gordon Mills, Gordon Ferguson, Sotiris Antoniou, Riyaz Patel, Sadeer Fhadil, Tasleem Damani, Paul Wright, Mick Ozkor, Debashish Das, Oliver P Guttmann, Andreas Baumbach, R Andrew Archbold, Andrew Wragg, Ajay K Jain, Fizzah A Choudry, Anthony Mathur, Daniel A Jones
Abstract
Background: Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care.
Objectives: This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients.
Methods: Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months.
Results: The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses.
Conclusions: Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.
Keywords: STEMI; early discharge; primary PCI.
Conflict of interest statement
Funding Support and Author Disclosures Dr Rathod has received funding from the National Institute for Health and Research (NIHR) in the form of an Academic Clinical Lectureship. Dr Jones has received funding from the Barts Charity; and has received financial support for blood pressure machines from the Barts Guild. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed