Feasibility of early hospital discharge directly from coronary care unit after primary angioplasty for uncomplicated acute myocardial infarction

• Authors: Andrej Pernat , Mitja Lainscak , Aleksandra Mohar , Marko Noc
• Languages of publication: EN

Abstracts

EN

Current European and American guidelines recommend early discharge for patients with uncomplicated acute myocardial infarction (AMI). However, this concept has not been widely accepted, and experience with direct discharge from the coronary care unit is limited. We aimed to investigate safety and cost effectiveness of early discharge directly from coronary care unit following successful percutaneous coronary angioplasty (PTCA) in patients with uncomplicated AMI. We included consecutive thirty-one patients with uncomplicated AMI and successful PTCA admitted to coronary care unit of a university hospital. Uncomplicated course was defined as absence of reinfarction, ischemia, VF/VT, repeated PTCA, and heart failure within first 72 hours. Incidence of death, reinfarction, VF/VT, need for revascularisation, and hospitalisation due to heart failure at 1, 6, and 12 months was compared with 56 randomly selected AMI patients with successful PTCA but longer hospitalisation. Average hospital stay was 4 days in early and 6.7 days in control group (p<0.05). Control group had more extensive coronary disease (54% two or more vessels vs. 28% in early discharge, p<0,05). During follow up, none of the early discharged patients died, the only observed event was repeat PTCA due to angina pectoris. In the control group, mortality at 12 months was 3.5% (p<0.05). Cumulative 12 month event free survival was 96% in early discharge group and 87% in control group, but difference was not significant (p=0.15, Cox-Mantel test). Cost reduction of early discharge amounted to 1100 Euro per patient. In conclusions, our study confirmed that for a selected population of patients with AMI, successful PTCA, and uncomplicated clinical course during first 72 hours, discharge as early as three days following the admission is safe.

Keywords

EN

Acute myocardial infarction; Early discharge; Primary angioplasty; Coronary care unit

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2009
• Volume: 4
• Issue: 2
• Pages: 212-217

Dates

published

1 - 6 - 2009

online

27 - 3 - 2009

Contributors

author

Andrej Pernat

• Department of Cardiology, University Medical Centre, SI-1000, Ljubljana, Slovenia

author

Mitja Lainscak

• Division of Cardiology, University Clinic of Respiratory and Allergic Diseases, SI-4204, Golnik, Slovenia

author

Aleksandra Mohar

• Department of Cardiology, University Medical Centre, SI-1000, Ljubljana, Slovenia

author

Marko Noc

• Centre for Intensive Internal Medicine, University Medical Centre, SI-1000, Ljubljana, Slovenia

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Identifiers

DOI

10.2478/s11536-009-0009-6