Sage Journals: Discover world-class research

Abstract

Background

Early discharge after successful primary angioplasty is common, but the evidence supporting the practice is still lacking. We therefore performed a meta-analysis assessing the safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction (STEMI).

Methods

Randomised controlled trials were identified and extracted from PubMed, Embase, Cochrane Library databases and reference lists of relevant papers. Heterogeneity was analysed using the I² test. If there was a lack of heterogeneity, fixed effects models would be used for the meta-analysis, otherwise random effects models were used. Statistical analyses were performed using Review Manager 5.3.

Results

Five randomised controlled trials involving 1575 STEMI patients met the criteria. Meta-analysis showed that the early discharge strategy group had a significantly shortened length of hospital stay compared to the conventional discharge strategy group (standardised mean difference −1.46, 95% confidence interval (CI) −2.04 to −0.88; P < 0.0001), and there was no difference in mortality and readmission rates between the two groups (risk ratio 0.78, 95% CI 0.50 to 1.22; P = 0.41).

Conclusions

The findings of this meta-analysis suggested that the early discharge strategy after successful primary angioplasty is safe among selected low-risk STEMI patients. A shorter hospital stay could benefit both the patients and the healthcare systems.

Keywords

STEMI primary angioplasty early discharge RCTs meta-analysis

Get full access to this article

View all access options for this article.

References

Ibanez

James

Agewall

et al.

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 Inpatients Presenting with ST-segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119–177.

McManus

Gore

Yarzebski

et al.

Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011; 124: 40–47.

Widimsky

Wijns

Fajadet

et al.

Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010; 31: 943–957.

Menees

Peterson

Wang

et al.

Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013; 369: 901–909.

Lamy

Tong

Bainey

et al.

Cost implication of an early invasive strategy on weekdays and weekends in patients with acute coronary syndromes. Can J Cardiol 2015; 31: 314–319.

Aasa

Henriksson

Dellborg

et al.

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. Am Heart J 2010; 160: 322–328.

Díez-Delhoyo

Valero-Masa

Velásquez-Rodríguez

et al.

Very low risk ST-segment elevation myocardial infarction? It exists and may be easily identified. Int J Cardiol 2017; 228: 615–620.

Higgins

Thompson

Deeks

et al.

Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

Jirmár

Widimský

Capek

et al.

Next day discharge after successful primary angioplasty for acute ST elevation myocardial infarction. An open randomized study “Prague-5”. Int Heart J 2008; 49: 653–659.

10.

Grines

Marsalese

Brodie

et al.

Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction. J Am Coll Cardiol 1998; 31: 967–972.

11.

Azzalini

Solé

Sans

et al.

Feasibility and safety of an early discharge strategy after low-risk acute myocardial infarction treated with primary percutaneous coronary intervention: the EDAMI pilot trial. Cardiology 2015; 130: 120–129.

12.

Satılmısoglu

Gorgulu

Aksu

et al.

Safety of early discharge after primary percutaneous coronary intervention. Am J Cardiol 2016; 117: 1911–1916.

13.

Melberg

Jørgensen

Ørn

et al.

Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial. Eur J Prev Cardiol 2015; 22: 1427–1434.

14.

Spencer

Lessard

Gore

et al.

Declining length of hospital stay for acute myocardial infarction and post discharge outcomes: a community-wide perspective. Arch Intern Med 2004; 164: 733–740.

15.

Berger

Duval

Jacobs

Jr et al.

Relation of length of hospital stay in acute myocardial infarction to post-discharge mortality. Am J Cardiol 2008; 101: 428–434.

16.

Topol

Burek

O'Neill

et al.

A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion. N Engl J Med 1988; 318: 1083–1088.

17.

Newby

Hasselblad

Armstrong

et al.

Time-based risk assessment after myocardial infarction. Implications for timing of discharge and applications to medical decision-making. Eur Heart J 2003; 24: 182–189.

18.

Agarwal

Parashar

Garg

et al.

Length of stay and long-term mortality following ST elevation myocardial infarction. Catheter Cardiovasc Interv 2015; 86: S1–S7.

19.

De Luca

Suryapranata

van't Hof

et al.

Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004; 109: 2737–2743.

20.

Sharkawi

Filippaios

Dani

et al.

Identifying patients for safe early hospital discharge following ST elevation myocardial infarction. Catheter Cardiovasc Interv 2017; 89: 1141–1146.

21.

De Luca

Suryapranata

van't Hof

et al.

Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004; 109: 2737–2743.

22.

Ganovska

Arrigo

Helanova

et al.

Natriuretic peptides in addition to Zwolle score to enhance safe and early discharge after acute myocardial infarction: A prospective observational cohort study. Int J Cardiol 2016; 215: 527–531.

23.

Tralhão

Ferreira

Madeira

et al.

Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Rev Port Cardiol 2015; 34: 535–541.

24.

Newby

Eisenstein

Califf

et al.

Cost effective ness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000; 342: 749–755.

25.

Swaminathan

Rao

McCoy

et al.

Hospital length of stay and clinical outcomes in older STEMI patients after primary PCI: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol 2015; 65: 1161–1171.

26.

Chernomordik

Sabbag

Tzur

et al.

Cardiac rehabilitation following an acute coronary syndrome: trends in referral, predictors and mortality outcome in a multicenter national registry between years 2006–2013: report from the Working Group on Cardiac Rehabilitation, the Israeli Heart Society. Eur J Prev Cardiol 2017; 24: 123–132.

27.

Piepoli

Corrà

Dendale

et al.

Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur J Prev Cardiol 2016; 23: 1994–2006.

28.

Peersen

Munkhaugen

Gullestad

et al.

The role of cardiac rehabilitation in secondary prevention after coronary events. Eur J Prev Cardiol 2017; 24: 1360–1368.

29.

Piepoli

Hoes

Agewall

et al.

2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23: NP1–NP96.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.41 MB

Safety of early discharge after primary angioplasty in low-risk patients with ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials

Abstract

Background

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material