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Very early discharge after PCI may be feasible in low-risk patients
Study findings suggest that discharging low-risk patients within 2 days of a successful primary PCI is feasible and safe, with more than 40% of patients with STEMI meeting early discharge criteria.
Researchers investigated the safety and feasibility of very early discharge at 2 days after primary PCI in selected low-risk cases through a prospective, observational cohort study of 2,779 patients treated from 2004 to 2011. Criteria for very early discharge included TIMI III flow, left ventricle ejection fraction >40%, and rhythmic and hemodynamic stability out to 48 hours.
Overall, 1,309 (49.3%) primary PCI patients met very early discharge criteria, of whom 1,117 (85.3%) were discharged at 2 days. Another 620 (23.4%) were discharged at 3 days, and 916 (34.5%) were discharged more than 3 days after admission (median, 5 days; interquartile range, 4-8 days).
Compared with patients discharged after 2 days, patients discharged at 2 days were younger and had lower rates of diabetes, renal dysfunction, multivessel CAD, previous MI and previous CABG.
The 30-day readmission rate for non-MACE events was 4.8% for patients discharged at 2 days, 4.9% for those discharged at 3 days and 4.6% for those discharged more than 3 days after admission. Patients discharged at 2 days had the lowest rate of MACE (9.6%; 95% CI, 4.7-16.6) compared with patients discharged at 3 days (12.3%; 95% CI, 6-19.2) and more than 3 days (28.6%; 95% CI, 22.9-34.7) after admission.
“However, we would like to emphasize that this study does not attempt to investigate the direct effect of length of hospital stay on outcome in a causative manner,” researchers wrote. “Rather, this study presents data regarding the feasibility and safety of an early discharge policy.”
Disclosure: Jones reports no relevant financial disclosures.