Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan.
BMJ Open. 2023 Apr 10;13(4):e067971. doi: 10.1136/bmjopen-2022-067971.
Knowledge regarding the short-term outcomes after same-day discharge (SDD) post primary percutaneous coronary intervention (PCI) is lacking. In this study, we evaluated 1-year major adverse cardiovascular events (MACE) among SDD patients after primary PCI.
1-year follow-up analysis of a subset of patients from an existing prospective cohort study.
Tertiary care cardiac hospital in Karachi, Pakistan.
Consecutive patients, from August 2019 to July 2020, with ST segment elevation myocardial infarction who had undergone primary PCI with SDD (within 24 hours) after the procedure by the treating physician and with at least one successful follow-up up to 1 year.
Cumulative MACE during follow-up at the intervals of 1 week, 1 month, 6 months and 1 year.
489 patients were included, with a gender distribution of 83.2% (407) male patients and a mean age of 54.58±10.85 years. Overall MACE rate during the mean follow-up duration of 326.98±76.71 days was 10.8% (53), out of which 26.4% (14/53) events occurred within 6 months of discharge and the remaining 73.6% (39/53) occurred between 6 months and 1 year. MACE was significantly higher among patients with a Zwolle Risk Score (ZRS) ≥4 at baseline, with an incidence rate of 21.9% (16/73) vs 8.9% (37/416; p=0.001) in patients with ZRS≤3 (relative risk 2.88 (95% CI 1.5 to 5.5)).
A significant burden of short-term MACE was identified among SDD patients after primary PCI; most of these events occurred after 6 months of SDD, mainly among patients with ZRS≥4. A systematic risk assessment based on risk stratification modalities such ZRS could be a viable option for SDD patients with primary PCI.
目前对于经皮冠状动脉介入治疗（PCI）后当日出院（SDD）患者的短期结局知之甚少。本研究旨在评估行 PCI 后 SDD 患者的 1 年主要不良心血管事件（MACE）。
对现有前瞻性队列研究中患者的亚组进行 1 年随访分析。
巴基斯坦卡拉奇的一家三级心脏医院。
连续入选 2019 年 8 月至 2020 年 7 月间因 ST 段抬高型心肌梗死行 PCI 治疗的患者，由主管医生行 SDD（术后 24 小时内），且至少在 1 年的随访中有 1 次成功随访。
在 1 周、1 个月、6 个月和 1 年随访期间累积 MACE。
共纳入 489 例患者，其中男性占 83.2%（407 例），平均年龄 54.58±10.85 岁。在平均 326.98±76.71 天的随访期间，总的 MACE 发生率为 10.8%（53 例），其中 26.4%（14/53）发生在出院后 6 个月内，其余 73.6%（39/53）发生在 6 个月至 1 年期间。基线 Zwolle 风险评分（ZRS）≥4 的患者 MACE 发生率显著更高，发生率为 21.9%（16/73），而 ZRS≤3 的患者发生率为 8.9%（37/416；p=0.001），风险比为 2.88（95%CI 1.5 至 5.5）。
在经 PCI 治疗的 SDD 患者中，发现短期 MACE 负担显著；大多数事件发生在 SDD 后 6 个月，主要发生在 ZRS≥4 的患者中。基于 ZRS 等风险分层模式的系统风险评估可能是行 PCI 治疗后 SDD 患者的可行选择。
