Sharkawi Musa A, Filippaios Andreas, Dani Saurabh S, Shah Sachin P, Riskalla Nabila, Venesy David M, Labib Sherif B, Resnic Frederic S
Department of Cardiovascular Medicine, Hartford Hospital, Hartford, Connecticut.
University of Connecticut School of Medicine, Farmington, Connecticut.
Catheter Cardiovasc Interv. 2017 Jun 1;89(7):1141-1146. doi: 10.1002/ccd.26873. Epub 2016 Nov 29.
To examine whether the CADILLAC risk score is an effective method of patient stratification for early discharge following ST elevation myocardial infarction (STEMI).
Patients with STEMI are typically hospitalized to monitor for serious complications such as arrhythmias, heart failure, and reinfarction. Optimal length of stay is unclear. Whether low risk patients can be safely discharged before 72 hr of hospitalization is unclear.
Patients with STEMI who underwent successful PCI were retrospectively stratified using CADILLAC risk score to low risk (n = 123) and intermediate to high risk (n = 105). The primary outcome was adverse clinical events at day 3 or later. Secondary outcomes were adverse clinical events on day 1 and mortality rates at 30 days and 31 to 365 days.
Low risk patients had lower major adverse clinical events at day 3 or later (0 vs. 11.4%, P = 0.0002) and lower total mortality at 1 year (0 vs. 4.8%, P = 0.02) than patients with intermediate to high risk. Low risk patients were also less likely to have a cardiovascular event during the first 24 hr when compared to those with an intermediate to high risk score (3.3% vs. 13.3%, P = 0.006).
Low risk patients identified using CADILLAC risk score with STEMI treated successfully with primary PCI have a low adverse event rate on the third day or later of hospitalization suggesting that an earlier discharge is safe in properly selected patients. Monitoring in a noncritical care setting following primary PCI for STEMI may be feasible for selected patients. © 2016 Wiley Periodicals, Inc.
探讨CADILLAC风险评分是否为ST段抬高型心肌梗死（STEMI）后早期出院患者分层的有效方法。
STEMI患者通常住院以监测严重并发症，如心律失常、心力衰竭和再梗死。最佳住院时长尚不清楚。低风险患者能否在住院72小时前安全出院尚不清楚。
对成功接受PCI的STEMI患者，采用CADILLAC风险评分进行回顾性分层，分为低风险组（n = 123）和中高风险组（n = 105）。主要结局为第3天或之后的不良临床事件。次要结局为第1天的不良临床事件以及30天和31至365天的死亡率。
与中高风险患者相比，低风险患者在第3天或之后的主要不良临床事件发生率更低（0%对11.4%，P = 0.0002），1年总死亡率也更低（0%对4.8%，P = 0.02）。与中高风险评分患者相比，低风险患者在最初24小时内发生心血管事件的可能性也更小（3.3%对13.3%，P = 0.006）。
对于成功接受直接PCI治疗的STEMI患者，使用CADILLAC风险评分识别出的低风险患者在住院第三天或之后不良事件发生率较低，这表明在经过适当选择的患者中提前出院是安全的。对于部分患者，在STEMI直接PCI后于非重症监护环境中进行监测可能是可行的。© 2016威利期刊公司
