Yousif Nooraldaem, Chachar Tarique S, Subbramaniyam Suddharsan, Vadgaonkar Vinayak, Noor Husam A
Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Kingdom of Bahrain.
J Saudi Heart Assoc. 2021 Apr 19;33(1):77-84. doi: 10.37616/2212-5043.1242. eCollection 2021.
The aim of the current study is to determine the safety of early discharge (ED) within 48 hours (h) for ST-elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PPCI) and to define the criteria of low-risk patients that can be considered for ED.
This is a single-center retrospective study that took place at Mohammed bin Khalifa Cardiac Centre in the Kingdom of Bahrain. 301 patients who underwent PPCI between January 2018 and March 2019 were included. Endpoints at 30 days follow-up comprised cardiac re-admission, cardiovascular death, non-fatal myocardial infarction, stroke, and major adverse cardiovascular and cerebrovascular events.
Of the 301 patients included in our study, 74 (24.5%) were discharged within 48 h (group 1) compared with 227 (75.5%) hospitalized for more than 48 h after PPCI (group 2) (<0.0001). In terms of baseline characteristics, group 2 had higher proportions of chronic kidney disease (P = 0.051), mean HbA1c (P = 0.016) and mean CPK (P < 0.0001) compared to their group 1 counterparts. The prevalence of anterior STEMI was twice as high among group 2 (P < 0.0001), with a significantly higher prevalence of left main stenting (P = 0.025). Additionally, larger proportion of group 2 required inotropic therapy (P = 0.031), oral anticoagulation (P = 0.005) and had a significantly lower ejection fraction (LVEF) (P < 0.0001) with more procedural complications (P = 0.005). LVEF exerts a large effect on ED, as reflected by a high deviance R = 20.4%, and was able to correctly classify the subjects into their pertaining discharge group with an accuracy of 80.4%, a specificity of 82.7%, and a sensitivity of 71.2%. According to the fitted LVEF values using the logistic equation, each 1% increase in LVEF is associated with a 3.5% increase in the chance of ED. The two groups recorded fairly similar clinical outcomes at 30-day.
Preserved LV systolic function is a good predictor of early and safe discharge after successful PPCI. The presented data support the practice of ED, with length of stay even shorter than current guidelines recommendation in selected low-risk patients.
本研究的目的是确定接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者在48小时内早期出院（ED）的安全性，并确定可考虑早期出院的低风险患者标准。
这是一项在巴林王国穆罕默德·本·哈利法心脏中心进行的单中心回顾性研究。纳入了2018年1月至2019年3月期间接受PPCI的301例患者。30天随访的终点包括心脏再入院、心血管死亡、非致命性心肌梗死、中风以及主要不良心血管和脑血管事件。
在我们研究纳入的301例患者中，74例（24.5%）在48小时内出院（第1组），相比之下，227例（75.5%）在PPCI后住院超过48小时（第2组）（P<0.0001）。在基线特征方面，与第1组相比，第2组慢性肾脏病、平均糖化血红蛋白（HbA1c）和平均肌酸磷酸激酶（CPK）的比例更高（P分别为0.051、0.016和P<0.0001）。第2组前壁STEMI的患病率是第1组的两倍（P<0.0001），左主干支架置入的患病率显著更高（P = 0.025）。此外，第2组需要使用正性肌力药物治疗、口服抗凝治疗的比例更高（P分别为0.031和0.005），射血分数（LVEF）显著更低（P<0.0001），手术并发症更多（P = 0.005）。LVEF对早期出院有很大影响，偏差R高达20.4%，能够将受试者正确分类到相应的出院组，准确率为80.4%，特异性为82.7%，敏感性为71.2%。根据使用逻辑方程拟合的LVEF值，LVEF每增加1%，早期出院的可能性增加3.5%。两组在30天时的临床结局相当相似。
左心室收缩功能保留是成功进行PPCI后早期安全出院的良好预测指标。本研究数据支持早期出院的做法，在选定的低风险患者中住院时间甚至比当前指南推荐的更短。
