Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge.
BACKGROUND
The aim of this study was to create a practical score for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty and to assess the feasibility of early discharge in low-risk patients.


RESULTS
A prognostic score was built according to 30-day mortality rates in 1791 patients undergoing primary angioplasty for STEMI. For the identified low-risk patients without any contraindication to early discharge, we estimated and compared the costs of conventional care (prolonged 24-hour hospitalization) with the costs of shifting the care from inpatient to outpatient setting (early discharge) between 48 and 72 hours. Independent predictors of 30-day mortality included in the score were age, anterior infarction, Killip class, ischemic time, postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow, and multivessel disease. This score was able to identify a large cohort (73.4%) of low-risk (score < or =3) patients, with a good discriminatory capacity (c statistic=0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score < or =3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at 1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of 194 933.33, in comparison with an early discharge policy.


CONCLUSIONS
This score is a practical and useful index for risk stratification after primary angioplasty for STEMI, with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.
De Luca
Giuseppe
G
Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
Suryapranata
Harry
H
van 't Hof
Arnoud W J
AW
de Boer
Menko-Jan
MJ
Hoorntje
Jan C A
JC
Dambrink
Jan-Henk E
JH
Gosselink
A T Marcel
AT
Ottervanger
Jan Paul
JP
Zijlstra
Felix
F
D000368:Aged; D017130:Angioplasty; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization; D011379:Prognosis; D018570:Risk Assessment