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Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention

BACKGROUND: 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 consider...

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Autores principales: Yousif, Nooraldaem, Chachar, Tarique S., Subbramaniyam, Suddharsan, Vadgaonkar, Vinayak, Noor, Husam A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Saudi Heart Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084303/
https://www.ncbi.nlm.nih.gov/pubmed/33936941
http://dx.doi.org/10.37616/2212-5043.1242
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author Yousif, Nooraldaem
Chachar, Tarique S.
Subbramaniyam, Suddharsan
Vadgaonkar, Vinayak
Noor, Husam A.
author_facet Yousif, Nooraldaem
Chachar, Tarique S.
Subbramaniyam, Suddharsan
Vadgaonkar, Vinayak
Noor, Husam A.
author_sort Yousif, Nooraldaem
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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(2) = 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. CONCLUSION: 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.
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spelling pubmed-80843032021-04-30 Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention Yousif, Nooraldaem Chachar, Tarique S. Subbramaniyam, Suddharsan Vadgaonkar, Vinayak Noor, Husam A. J Saudi Heart Assoc Original Article BACKGROUND: 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. METHODS: 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. RESULTS: 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(2) = 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. CONCLUSION: 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. Saudi Heart Association 2021-04-19 /pmc/articles/PMC8084303/ /pubmed/33936941 http://dx.doi.org/10.37616/2212-5043.1242 Text en © 2021 Saudi Heart Association https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Original Article
Yousif, Nooraldaem
Chachar, Tarique S.
Subbramaniyam, Suddharsan
Vadgaonkar, Vinayak
Noor, Husam A.
Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title_full Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title_fullStr Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title_full_unstemmed Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title_short Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention
title_sort safety and feasibility of 48 h discharge after successful primary percutaneous coronary intervention
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084303/
https://www.ncbi.nlm.nih.gov/pubmed/33936941
http://dx.doi.org/10.37616/2212-5043.1242
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