Bawamia Bilal, Brown Andrew, Spyridopoulos Ioakim, Bagnall Alan, Edwards Richard, Purcell Ian, Egred Mohaned, Zaman Azfar, Alkhalil Mohammad
Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK.
Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Cardiovasc Revasc Med. 2023 Jan;46:12-18. doi: 10.1016/j.carrev.2022.08.022. Epub 2022 Aug 18.
Current guidelines recommend that low risk patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing uncomplicated primary percutaneous coronary intervention (PPCI) can be discharged home in 48-72 h. We report the safety of early discharge in STEMI patients undergoing uncomplicated PPCI after 24-h stay in-hospital.
We performed a retrospective analysis of prospectively collected data of consecutive patients presenting with STEMI between January 2014 and December 2020. One- and 6-month mortality rates were compared between patients who underwent next day (early discharge group) and two days in-hospital stay (standard discharge group).
Of 6119 STEMI patients, 4033 were included in the analysis, of whom 1674 (42 %) underwent early discharge. Patients in the early discharge group were younger, more likely to be male, and had a lower peak troponin. Both groups had similar ischemia- and door-to-balloon time, but anterior STEMI were less frequent in the early discharge group. The 1- and 6-month mortality rate for the whole cohort was 0.6 % and 1.3 %, respectively. After adjustment, there were no significant differences in the 1-month [HR 0.54; 95 % CI (0.20 to 1.47), P = 0.23] and 6-month mortality [HR 0.73; 95 % CI (0.38 to 1.41), P = 0.35] between early and standard discharge groups. Age, admission heart rate and chronic obstructive lung disease were identified as independent predictors of 6-month mortality in patients who underwent early discharge strategy.
Our data confirms safety of next day discharge of patients presenting with STEMI after successful PPCI and uncomplicated post-procedural course.
当前指南建议，出现ST段抬高型心肌梗死（STEMI）且接受无并发症的直接经皮冠状动脉介入治疗（PPCI）的低风险患者可在48 - 72小时内出院回家。我们报告了在住院24小时后接受无并发症PPCI的STEMI患者早期出院的安全性。
我们对2014年1月至2020年12月期间连续出现STEMI的患者的前瞻性收集数据进行了回顾性分析。比较了次日出院（早期出院组）和住院两天（标准出院组）的患者1个月和6个月的死亡率。
在6119例STEMI患者中，4033例纳入分析，其中1674例（42%）接受早期出院。早期出院组患者更年轻，男性比例更高，肌钙蛋白峰值更低。两组的缺血时间和门球时间相似，但早期出院组前壁STEMI的发生率较低。整个队列的1个月和6个月死亡率分别为0.6%和1.
