Early and Very Early Discharge After Uncomplicated Primary PCI: A Comparative Observational Study

Zohaib Sadiq; Sarmad Zahoor; Shirjeel Murtaza; Sadia Iqbal; Uzma Majeed; Muhammad Arshad

doi:10.70749/ijbr.v3i2.621

Authors

Zohaib Sadiq Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.
Sarmad Zahoor Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.
Shirjeel Murtaza Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.
Sadia Iqbal Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.
Uzma Majeed Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.
Muhammad Arshad Department of Cardiology, Punjab Institute of Cardiology, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i2.621

Keywords:

Acute Myocardial Infarction, Early Discharge, Percutaneous Coronary Intervention, Hospital Stay, Cardiac Care, Healthcare Cost

Abstract

Acute Myocardial Infarction (AMI) continues to be a leading cause of mortality worldwide. The standard treatment involves prompt management with Primary Percutaneous Coronary Intervention (PPCI); however, the optimal duration of hospital stay following PPCI remains an area of ongoing investigation. This study aimed to assess the safety and outcomes associated with very early discharge (VED) in patients after uncomplicated PPCI. This prospective observational study included 148 STEMI patients treated at a leading cardiac center in Lahore, Pakistan, from August 2022 to August 2023. Participants were categorized into two groups: those discharged within 24 hours (very early discharge group) and those discharged between 24 and 48 hours (early discharge group) post-PPCI. Baseline characteristics, procedural details, and early outcomes were documented. The primary outcomes were Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 7-day and 30-day follow-ups. Data analysis was performed using Student's t-tests, Chi-square tests, and logistic regression. A p-value of ≤0.05 was deemed statistically significant. The primary outcomes were assessed as Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 7-day and 30-day follow-ups. The study found no significant differences in MACCE rates between the very early discharge group (5.43% at 7 days and 10.8% at 30 days) and the early discharge group (5.35% at 7 days and 10.7% at 30 days), with p-values of 0.98 and 0.97, respectively. VED criteria included successful PCI, LVEF ≥ 40%, and no major in-hospital complications. The discharge of low-risk patients within 24 hours after uncomplicated PPCI was found to be safe and feasible and indeed an effective strategy to improve bed utilization and reduce healthcare cost without increasing the risk for adverse outcome.

Downloads

Download data is not yet available.

References

Aasa, M., Henriksson, M., Dellborg, M., Grip, L., Herlitz, J., Levin, L., Svensson, L., & Janzon, M. (2010). Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction—Results of the Swedish early decision reperfusion study (SWEDES) trial. American Heart Journal, 160(2), 322-328. https://doi.org/10.1016/j.ahj.2010.05.008

Brayton, K. M., Patel, V. G., Stave, C., De Lemos, J. A., & Kumbhani, D. J. (2013). Same-day discharge after percutaneous coronary intervention. Journal of the American College of Cardiology, 62(4), 275-285. https://doi.org/10.1016/j.jacc.2013.03.051

De Luca, G., Suryapranata, H., Van’t Hof, A. W., De Boer, M., Hoorntje, J. C., Dambrink, J. E., Gosselink, A. M., Ottervanger, J. P., & Zijlstra, F. (2004). Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty. Circulation, 109(22), 2737-2743. https://doi.org/10.1161/01.cir.0000131765.73959.87

Ding, J., Zhang, X., Hu, X., Chen, H., & Yu, M. (2017). Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi’an, China. Medicine, 96(51), e9341. https://doi.org/10.1097/md.0000000000009341

ESC, S. G. (2018). The task force for the management of acute myocardial infarction in patients presenting with St-segment elevation of the European Society of Cardiology (Esc) 2017 esc guidelines for themanagement of acutemyocardial infarction in patients presenting with St-segment elevation. Russian Journal of Cardiology, (5), 103-158. https://doi.org/10.15829/1560-4071-2018-5-103-158

Gong, W., Li, A., Ai, H., Shi, H., Wang, X., & Nie, S. (2018). Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials. European Journal of Preventive Cardiology, 25(8), 807-815. https://doi.org/10.1177/2047487318763823

Halkin, A., Singh, M., Nikolsky, E., Grines, C. L., Tcheng, J. E., Garcia, E., Cox, D. A., Turco, M., Stuckey, T. D., Na, Y., Lansky, A. J., Gersh, B. J., O’Neill, W. W., Mehran, R., & Stone, G. W. (2005). Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction. Journal of the American College of Cardiology, 45(9), 1397-1405. https://doi.org/10.1016/j.jacc.2005.01.041

Hosseini, S. K., Naghshtabrizi, B., Emami, F., Yazdi, A., Naghshtabrizi, N., & Zebarjadi, S. (2022). Very early discharge of patients with ST-segment-Elevation myocardial infarction after primary percutaneous coronary intervention. The Journal of Tehran University Heart Center. https://doi.org/10.18502/jthc.v16i3.8188

Howard, J. P., Jones, D. A., Gallagher, S., Rathod, K., Jain, A., Mohiddin, S., Knight, C., Mathur, A., Smith, E. J., & Wragg, A. (2012). 048 Is it safe to discharge patients 24 h after uncomplicated successful primary percutaneous coronary intervention?: Abstract 048 Table 1. Heart, 98(Suppl 1), A29-A30. https://doi.org/10.1136/heartjnl-2012-301877b.48

Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L., Crea, F., Goudevenos, J. A. & Halvorsen, S. 2018. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, 39(2), pp 119-177.

Jirmár, R., Widimský, P., Capek, J., Hlinomaz, O., & Groch, L. (2008). Next day discharge after successful primary angioplasty for acute ST elevation myocardial infarction an open randomized study "Prague-5". International Heart Journal, 49(6), 653-659. https://doi.org/10.1536/ihj.49.653

Jones, D. A., Rathod, K. S., Howard, J. P., Gallagher, S., Antoniou, S., De Palma, R., Guttmann, O., Cliffe, S., Colley, J., Butler, J., Ferguson, E., Mohiddin, S., Kapur, A., Knight, C. J., Jain, A. K., Rothman, M. T., Mathur, A., Timmis, A. D., Smith, E. J., … Wragg, A. (2012). Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction. Heart, 98(23), 1722-1727. https://doi.org/10.1136/heartjnl-2012-302414

Kociol, R. D., Lopes, R. D., Clare, R., Thomas, L., Mehta, R. H., Kaul, P., Pieper, K. S., Hochman, J. S., Weaver, W. D., Armstrong, P. W., Granger, C. B., & Patel, M. R. (2012). International variation in and factors associated with hospital readmission after myocardial infarction. JAMA, 307(1), 66. https://doi.org/10.1001/jama.2011.1926

Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., ... & Zwischenberger, B. A. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(2), e21-e129. https://www.jacc.org/doi/abs/10.1016/j.jacc.2021.09.006

Rathod, K. S., Comer, K., Casey-Gillman, O., Moore, L., Mills, G., Ferguson, G., Antoniou, S., Patel, R., Fhadil, S., Damani, T., Wright, P., Ozkor, M., Das, D., Guttmann, O. P., Baumbach, A., Archbold, R. A., Wragg, A., Jain, A. K., Choudry, F. A., … Jones, D. A. (2021). Early hospital discharge following PCI for patients with STEMI. Journal of the American College of Cardiology, 78(25), 2550-2560. https://doi.org/10.1016/j.jacc.2021.09.1379

Roffi, M., Patrono, C., Collet, J., Mueller, C., Valgimigli, M., Andreotti, F., Bax, J. J., Borger, M. A., Brotons, C., Chew, D. P., Gencer, B., Hasenfuss, G., Kjeldsen, K., Lancellotti, P., Landmesser, U., Mehilli, J., Mukherjee, D., Storey, R. F., & Windecker, S. (2015). 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 37(3), 267-315. https://doi.org/10.1093/eurheartj/ehv320

Rubimbura Mazimpaka, V., Rostain, L., Duval, A., Akakpo, S., Boukantar, M., Boiron, P., Dubois-Rande, J., & Teiger, E. (2017). 5705Outcome and safety of same-day discharge after percutaneous coronary intervention: A 10 year single center experience. European Heart Journal, 38(suppl_1). https://doi.org/10.1093/eurheartj/ehx493.5705

Rubimbura, V., Rostain, L., Duval, A., Akakpo, S., Boukantar, M., Boiron, P., Mouillet, G., Gallet, R., Belarbi, A., Le Corvoisier, P., Dubois‐Randé, J., & Teiger, E. (2019). Outcomes and safety of same‐day discharge after percutaneous coronary intervention: A 10‐year single‐center study. Catheterization and Cardiovascular Interventions, 94(1), 105-111. https://doi.org/10.1002/ccd.28084

Samad, Z., Noorali, A. A., Farhad, A., Awan, S., Qureshi, N. Q., Mawani, M., Ali, M., Masood, L., Adnan, G., Shaw, L. K., Jafary, F. H., Virani, S. S., Velazquez, E. J., Bhutta, Z., Bloomfield, G. S., & Tai, J. (2022). Leveraging clinical digitized data to understand temporal characteristics and outcomes of acute myocardial infarctions at a tertiary care Medical Centre in Pakistan from 1988–2018 – Methods and results. Global Heart, 17(1). https://doi.org/10.5334/gh.1147

Satılmısoglu, M. H., Gorgulu, S., Aksu, H. U., Aksu, H., Ertaş, G., Tasbulak, O., Buturak, A., Kalkan, A. K., Degirmencioglu, A., Koroglu, B., Tusun, E., Murat, A., & Oz, A. (2016). Safety of early discharge after primary percutaneous coronary intervention. The American Journal of Cardiology, 117(12), 1911-1916. https://doi.org/10.1016/j.amjcard.2016.03.039

Schellings, D. A., Adiyaman, A., Giannitsis, E., Hamm, C., Suryapranata, H., Ten Berg, J. M., Hoorntje, J. C., & Van‘t Hof, A. W. (2014). Early discharge after primary percutaneous coronary intervention: The added value of N‐terminal pro–brain Natriuretic peptide to the Zwolle risk score. Journal of the American Heart Association, 3(6). https://doi.org/10.1161/jaha.114.001089

Shah, J. A., Saghir, T., Ahmed, B., Ul Haq, S. A., Kumar, R., Mengal, M. N., Zehra, M., Raza, S. S., Karim, M., & Qamar, N. (2023). Same day discharge strategy for primary percutaneous coronary intervention: A safety and feasibility approach. Current Overview on Disease and Health Research Vol. 9, 46-58. https://doi.org/10.9734/bpi/codhr/v9/5124a

Shah, J. A., Saghir, T., Ahmed, B., Ul Haq, S. A., Kumar, R., Mengal, M. N., Zehra, M., Raza, S. S., Karim, M., & Qamar, N. (2021). Safety and feasibility of same day discharge strategy for primary percutaneous coronary intervention. Global Heart, 16(1). https://doi.org/10.5334/gh.1035

Shroff, A., Kupfer, J., Gilchrist, I. C., Caputo, R., Speiser, B., Bertrand, O. F., Pancholy, S. B., & Rao, S. V. (2016). Same-day discharge after percutaneous coronary intervention. JAMA Cardiology, 1(2), 216. https://doi.org/10.1001/jamacardio.2016.0148

Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., & Ho, J. E. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8). https://doi.org/10.1161/cir.0000000000001123