[Uncomplicated acute myocardial infarction -- when should the patient be discharged?].
OBJECTIVE
Hospital discharge on day 10 after acute myocardial infarction (AMI) is still frequent in our hospital. The present study aims at evaluating the occurrence of cardiac events on day 5, 7 and 10, in patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, as well as a cost-effectiveness analysis on an earlier discharge.


METHODS
We retrospectively studied consecutive patients admitted with AMI for a period of 5 years, submitted to thrombolysis who suffered no events (recurrent ischemia, reinfarction, coronary revascularization, heart failure, arrhythmias implicating electric cardioversion or dysfibrilation, pacemaker or death) within the first 72 hours (n = 128; 101 males and 27 females, mean age 64.1 +/- 12.8). Patients were divided into two groups, with no events occurring by discharge (group I, n = 119) or with events between 72 hours and discharge (group II, n = 9). The latter were subdivided according to whether events occurred between 72 hours and day 5, between days 6 and 7 or between 8 and 10.


RESULTS
Group I and II were not significantly different regarding vascular risk factors, prior coronary disease and infarction location. Group I was mainly constituted of males, younger than those in group II and with preserved systolic LV function. Between 72 hours and discharge, there were no events in 93% of the patients (119) and events occurred in 7% (9 patients). Two cases of cardiac events occurred until day 5 (1.6%) one angina and one death, two patients with complications between days 6 and 7 (1.6%), both heart failure, and 5 patients suffered events after day 7 (4%), 3 angina and 2 deaths. Dead patients (3 cases--2.3%) were older, had prior AMI, mostly with unpreserved systolic LV function and prior ischemic heart disease. All of them had sudden death. The most frequent non-fatal complications were recurrent ischemia and heart failure.


CONCLUSIONS
In patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, the risk of cardiac events by the 10th day is low. It occurs randomly in time. In this group of patients it seems of no effectiveness to lengthen hospitalization. An earlier discharge may be advantageous since it does not significantly increase the risk that a longer hospitalization could prevent.
Ribeiro
A
A
Serviço de Cardiologia, Hospital Santa Luzia, 4900-496 Viana do Castelo.
Moura
P
P
Azevedo
L
L
Ferrão
B
B
Marques
A
A
Lopes
M A
MA
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010351:Patient Discharge; D012189:Retrospective Studies