Bermejo García J, Muñoz San José J C, de la Fuente Galán L, Alvarez Ruiz A, Rubio Sanz J, Gimeno de Carlos F, Durán Hernández J M, García Morán E, Paniagua Olmedillas J, Alonso Martín J J, Fernández-Avilés F
Servicio de Cardiología, Hospital Universitario, Valladolid.
Rev Esp Cardiol. 1998 Mar;51(3):192-8. doi: 10.1016/s0300-8932(98)74732-3.
The high demand for health care has obliged Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objective have been: a) to analyse the characteristics and the evolution (death or readmission) during the first month of patients with myocardial infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group patients for complications who could be discharged early from the Coronary Unit.
A study of 978 consecutive patients who had been admitted for acute myocardial, in faration were divided into two groups according to their length of stay in the Coronary Unit (A < or = 2 and B > 2 days). Their baseline characteristics, course of stay and vital status at month, were compared. A subgroup of patients at low risk was studied and complications that might have arisen from their early discharge from the Coronary Unit were assessed.
Seventy-three patients (7.5%) died within the first two days. Of the remaining 905, the stay was 2 days or less for 336 patients (group A); and longer than 2 days for 569 (group B). Group A had a higher frequency of dyslipemia, Killip class I on admission, uncomplicated myocardial infarction in the Coronary Unit and the use of beta-blockers and had less frequency of diabetes, Q wave myocardial infarction, anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 18 patients from group B died, the rate of death or readmission into the Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip class on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary unit. A subset of 378 low risk patients (Killip I on admission, uncomplicated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgroup, those patients whose stay was equal to or less than two days were more frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034).
Selected patients with myocardial infarction can be discharged very early from the Coronary Unit with a low risk of death. A readmission rate following discharge of some 5% must be allowed for these patients.
对医疗保健的高需求迫使冠心病监护病房加快病情不太严重患者的出院速度，这可能会对他们的预后产生影响。我们的目标是：a）分析心肌梗死且从冠心病监护病房极早期出院（住院2天或更短时间）患者在第一个月的特征及病情发展（死亡或再入院情况）；b）评估可能从冠心病监护病房早期出院的并发症极低风险组患者的情况。
对978例因急性心肌梗死入院的连续患者，根据其在冠心病监护病房的住院时间分为两组（A组≤2天，B组>2天）。比较两组患者的基线特征、住院过程及出院一个月时的生命状态。对低风险患者亚组进行研究，并评估其从冠心病监护病房早期出院可能引发的并发症。
73例患者（7.5%）在头两天内死亡。其余905例中，336例患者（A组）住院2天或更短时间；569例患者（B组）住院时间超过2天。A组血脂异常、入院时Killip分级为I级、在冠心病监护病房无并发症性心肌梗死以及使用β受体阻滞剂的频率较高，而糖尿病、Q波心肌梗死、前壁梗死或使用纤溶药物的频率较低。从冠心病监护病房出院后的第一个月，A组有10例患者死亡，B组有18例患者死亡，两组在30天内的死亡率或再入院率相似（A组=13%，B组=13%）。多元回归分析显示，入院时的Killip分级（p<0.001）和无并发症病程（p<0.001）与在冠心病监护病房的住院时间独立相关。378例低风险患者亚组（入院时Killip I级、在重症监护病房无并发症病程且年龄<71岁）在30天时无死亡病例，其第一个月的再入院率为4%。在该亚组中，住院时间等于或少于两天的患者在第一周内再入院的频率更高（A组=9/197[5%]，B组=1/181[0.5%]；p=0.034）。
部分选定的心肌梗死患者可从冠心病监护病房极早期出院，死亡风险较低。对于这些患者，出院后的再入院率约为5%。
