Early Hospital Discharge Of Patients With Uncomplicated Acute Myocardial Infarcation PDF Download

For the past several decades, lengths of hospital stays after a ST-segment elevation myocardial infarction (STEMI) have considerably shortened and, moreover, the short-term prognostic of STEMI's has improved as well. The aim of this study was to assess the safety of an early discharge from the Cardiology Intensive Care Unit (CICU) following a STEMI in non-selected patients under “real-life” conditions and to describe the determinants taken into consideration. We retrospectively analysed the data of patients with STEMI that survived to hospital discharge between 2009 and 2013 using the OSCAR Registry Database: a multicenter observational cohort study taken from the French RESCUe network. The primary clinical end-point was all-cause mortality at one-year follow-up. A logistic regression was performed to find the determinants favorable for early discharge. 2031 STEMI patients were included in this study. 680 patients (34%) were discharged within two days of admission (early discharge group) and 1351 patients (66%) after two days (late discharge group). The early discharged patients were younger and less likely to have had diabetes, anterior myocardial infarction and reduced left ventricular ejection fraction. At one-year follow-up, 27 patients (1.3%) had died: 6 (0.9%) in the early discharge group and 21 (1.6%) in the late discharge group with no significant statistical differences in their survival rates. The determinants of early discharge in multivariate logistic regression analysis were age 65 years, no anterior myocardial infarction location, an initial TIMI flow grade 3, no serum creatinine level elevation ( 120μmol/L), no rise in troponin (> 23μg/L) and no cardiac arrest. This study confirms that a strategy of early hospital discharge within two days of admission after a STEMI does not raise the risk of mortality in selected patients. Moreover, it would certainly have important costefficiency impacts.