Early discharge in acute myocardial infarction after clinical and angiographic risk assessment.
BACKGROUND
Acute myocardial infarction (AMI) management aims to ensure the best care for patients while reducing hospital stay. The aim of this study was to evaluate feasibility and safety of early discharge (defined as discharge between 48 and 72 h from AMI) in low-risk patients after uncomplicated infarction.


METHODS
We prospectively evaluated 321 patients (age: 59 +/- 11.7), who were admitted for AMI between February 2004 and August 2005 and assigned to 'low'-risk and 'high'-risk groups according to clinical and angiographic criteria. Low-risk patients were discharged between 48 and 72 h from admission. After discharge, all patients were re-evaluated after 1 week, 6 weeks and 6 months for AMI. We also retrospectively considered a control group of 68 low-risk patients with AMI admitted to our Coronary Intensive Care Unit (CICU) in the previous 4 months before the beginning of the study with standard discharge after at least 7 days of hospital stay.


RESULTS
No events were detected in the first week after discharge. In low-risk patients, the cumulative major adverse event rate was 0.6% after 6 weeks, whereas in high-risk patients, the rate was 9% (P < or = 0.01). After 6 months, in the low-risk group, the cumulative major adverse event rate was 2%, whereas in the high-risk group, it was 10% (P < or = 0.01). The control group showed a cumulative major adverse event rate of 1.5% after 6 months, with no statistically significant difference between controls and low-risk patients. The type of AMI did not influence risk assessment and clinical outcome.


CONCLUSIONS
Our data support the short-term safety and cost-effectiveness of early discharge in patients with uncomplicated AMI, treated with successful percutaneous coronary intervention.
Branca
Giuseppina
G
Cardiology Department, Ferrarotto University Hospital, Catania, Italy.
Capodanno
Davide
D
Capranzano
Piera
P
Barbagallo
Rossella
R
Seminara
Dario
D
Licciardello
Giovanni
G
Tamburino
Corrado
C
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010351:Patient Discharge / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors