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Safety of early hospital discharge following admission with ST-elevation myocardial infarction treated with percutaneous coronary intervention : A nationwide cohort study

Yndigegn, Troels LU ; Gilje, Patrik LU ; Dankiewicz, Josef LU orcid ; Mokhtari, Arash LU ; Isma, Nazim LU ; Holmqvist, Jasminka ; Schiopu, Alexandru LU ; Ravn-Fischer, Annika ; Hofmann, Robin and Szummer, Karolina , et al. (2022) In EuroIntervention 17(13). p.1091-1099
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Early discharge, Length of hospital stay PAMI-II, STEMI
in
EuroIntervention
volume
17
issue
13
pages
9 pages
publisher
Société Europa Edition
external identifiers
  • scopus:85123879447
  • pmid:34338642
ISSN
1774-024X
DOI
10.4244/EIJ-D-21-00501
language
English
LU publication?
yes
id
6decdc75-2e61-4fc9-b666-4e90a155a3dc
date added to LUP
2022-04-06 16:00:25
date last changed
2024-05-22 22:27:24
@article{6decdc75-2e61-4fc9-b666-4e90a155a3dc,
  abstract     = {{<p>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 &gt;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 &gt;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.</p>}},
  author       = {{Yndigegn, Troels and Gilje, Patrik and Dankiewicz, Josef and Mokhtari, Arash and Isma, Nazim and Holmqvist, Jasminka and Schiopu, Alexandru and Ravn-Fischer, Annika and Hofmann, Robin and Szummer, Karolina and Jernberg, Tomas and James, Stefan and Gale, Chris P. and Frobert, Ole and Mohammad, Moman A.}},
  issn         = {{1774-024X}},
  keywords     = {{Early discharge; Length of hospital stay PAMI-II; STEMI}},
  language     = {{eng}},
  number       = {{13}},
  pages        = {{1091--1099}},
  publisher    = {{Société Europa Edition}},
  series       = {{EuroIntervention}},
  title        = {{Safety of early hospital discharge following admission with ST-elevation myocardial infarction treated with percutaneous coronary intervention : A nationwide cohort study}},
  url          = {{http://dx.doi.org/10.4244/EIJ-D-21-00501}},
  doi          = {{10.4244/EIJ-D-21-00501}},
  volume       = {{17}},
  year         = {{2022}},
}