Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial

1. Tor Melberg
2. Marianne Jørgensen
3. Stein Ørn
4. Torhild Solli
5. Unni Edland
6. Kenneth Dickstein

1. Department of Cardiology, Stavanger University Hospital, Stavanger, Norway

1. Tor Melberg, Department of Cardiology, Stavanger University Hospital, Armauer Hansensvei 21, Postbox 8100, 4068 Stavanger, Norway. Email: tormelberg@gmail.com

Abstract

Background Early discharge after uncomplicated primary percutaneous coronary intervention (PPCI) is common but the evidence supporting this practice is lacking. We therefore performed a randomized, prospective trial comparing outcomes in low risk PPCI randomized to early discharge or usual care.

Design and methods Over a two years period, all surviving PPCI patients at a single teaching hospital were considered eligible if the Zwolle risk score ≤3. They were randomized to either discharge ≤3 days or usual care. All included patients had routine medical treatment, counselling and follow-up. Health status and all readmissions up to 30 days follow-up were tracked.

Results Of 425 consecutive PPCI patients, 215 (50.6%) were randomized to either early discharge (n = 108) or usual routine discharge (n = 107). The mean index length of stay (LOS) plus the 30 days readmissions length of stay in the early discharge group was lower than in the usual discharge group: 2.7 ± 0.5 days vs 3.0 ± 0.7 days (p = 0.001). During follow-up there were no deaths, and similar readmission rate (4 (3.7%) vs 3 (2.8%), p = 0.69 in the early vs usual discharge group respectively). There was no difference in the 30 days health status measurements. The excluded high-risk group (n = 210) had longer index LOS (total sum 1314 vs 501 days, p = 0.001), and a trend towards more readmissions (10 (4.8%) vs 7 (3.3%) (p = 0.19)).

Conclusion It is feasible and safe to discharge low-risk PPCI patients within three days.