Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial.
BACKGROUND
Early discharge after uncomplicated primary percutaneous coronary intervention (PPCI) is common but the evidence supporting this practice is lacking. We therefore performed a randomized, prospective trial comparing outcomes in low risk PPCI randomized to early discharge or usual care.


METHODS
Over a two years period, all surviving PPCI patients at a single teaching hospital were considered eligible if the Zwolle risk score ≤3. They were randomized to either discharge ≤3 days or usual care. All included patients had routine medical treatment, counselling and follow-up. Health status and all readmissions up to 30 days follow-up were tracked.


RESULTS
Of 425 consecutive PPCI patients, 215 (50.6%) were randomized to either early discharge (n = 108) or usual routine discharge (n = 107). The mean index length of stay (LOS) plus the 30 days readmissions length of stay in the early discharge group was lower than in the usual discharge group: 2.7 ± 0.5 days vs 3.0 ± 0.7 days (p = 0.001). During follow-up there were no deaths, and similar readmission rate (4 (3.7%) vs 3 (2.8%), p = 0.69 in the early vs usual discharge group respectively). There was no difference in the 30 days health status measurements. The excluded high-risk group (n = 210) had longer index LOS (total sum 1314 vs 501 days, p = 0.001), and a trend towards more readmissions (10 (4.8%) vs 7 (3.3%) (p = 0.19)).


CONCLUSIONS
It is feasible and safe to discharge low-risk PPCI patients within three days.
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway tormelberg@gmail.com.
Tor
T
Melberg
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Marianne
M
Jørgensen
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Stein
S
Ørn
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Torhild
T
Solli
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Unni
U
Edland
Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Kenneth
K
Dickstein
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006304:Health Status; D061847:Hospitals, High-Volume; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009664:Norway; D010351:Patient Discharge; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Myocardial infarction; length of hospital stay; primary PCI; safety