低风险急性心肌梗死患者直接血管成形术后早期出院的安全性和成本效益。PAMI-II研究人员。心肌梗死直接血管成形术。

Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction.

作者信息

Grines C L, Marsalese D L, Brodie B, Griffin J, Donohue B, Costantini C R, Balestrini C, Stone G, Wharton T, Esente P, Spain M, Moses J, Nobuyoshi M, Ayres M, Jones D, Mason D, Sachs D, Grines L L, O'Neill W

机构信息

Division of Cardiology, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA.

出版信息

J Am Coll Cardiol. 1998 Apr;31(5):967-72. doi: 10.1016/s0735-1097(98)00031-x.

DOI:10.1016/s0735-1097(98)00031-x

PMID:9561995

Abstract

OBJECTIVES

The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients.

BACKGROUND

In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay.

METHODS

Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate. Low risk patients (age <70 years, left ventricular ejection fraction >45%, one- or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [n = 237] or traditional care [n = 234]).

RESULTS

Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4.2+/-2.3 vs. 7.1+/-4.7 days, p = 0.0001) and had lower hospital costs ($9,658+/-5,287 vs. $11,604+/-6,125 p = 0.002) than the patients who received traditional care. At 6 months, accelerated and traditional care groups had a similar rate of mortality (0.8% vs. 0.4%, p = 1.00), unstable ischemia (10.1% vs. 12.0%, p = 0.52), reinfarction (0.8% vs. 0.4%, p = 1.00), stroke (0.4% vs. 2.6%, p = 0.07), congestive heart failure (4.6% vs. 4.3%, p = 0.85) or their combined occurrence (15.2% vs. 17.5%, p = 0.49). The study was designed to detect a 10% difference in event rates; at 6 months, only a 2.3% difference was measured between groups, indicating an actual power of 0.19.

CONCLUSIONS

Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing, and a day 3 hospital discharge strategy, resulting in substantial cost savings.

摘要

目的

第二次心肌梗死直接血管成形术（PAMI-II）研究评估了这样一个假设，即对于低风险患者，直接经皮腔内冠状动脉血管成形术（PTCA），随后在3天后出院，是安全且具有成本效益的。

背景

在低风险心肌梗死（MI）患者中，关于重症监护需求、无创检查需求或合适的住院时长的数据很少。

方法

急性MI患者在适当的时候接受了急诊导管插入术及直接PTCA。低风险患者（年龄<70岁，左心室射血分数>45%，单支或双支血管病变，PTCA成功，无持续性心律失常）被随机分组，分别接受加速护理（入住非重症监护病房，第3天出院，无需无创检查[n = 237]）或传统护理[n = 234]）。

结果

接受加速护理的患者住院结局相似，但出院时间提前3天（4.2±2.3天对7.1±4.7天，p = 0.0001），且住院费用低于接受传统护理的患者（9,658±5,287美元对11,604±6,125美元，p = 0.002）。在6个月时，加速护理组和传统护理组的死亡率（0.8%对0.4%，p = 1.00）、不稳定型心绞痛（10.1%对12.0%，p = 0.52）、再梗死（0.8%对0.4%，p = 1.00）、中风（0.4%对2.6%，p = 0.07）、充血性心力衰竭（4.6%对4.3%，p = 0.85）或这些情况的合并发生率（15.2%对17.5%，p = 0.49）相似。该研究旨在检测事件发生率有10%的差异；在6个月时，两组之间仅测量到2.3%的差异，表明实际检验效能为0.19。