Clinical Outcomes of Early Versus Delayed Discharge After Primary Percutaneous Coronary Intervention
DOI:
https://doi.org/10.55958/jcvd.v18i4.119Keywords:
ST Elevation Myocardial Infarction, Primary Percutaneous Coronary Intervention, Early Discharge, Delayed DischargeAbstract
BACKGROUND: Heart disease is the most significant cause of death worldwide and ST- elevation myocardial infarction (STEMI) is a prime cause of death in developing nations. PCI has progressed to the point where overnight monitoring is unnecessary for some patients because of its increased safety and effectiveness. Improved patient satisfaction, shorter hospital stays, and more efficient use of healthcare resources are the key advantages of same-day release following PCI. PCI has always been viewed as an inpatient or short-stay surgery, requiring up to 24 hours of observation time. The purpose of this research was to make comparison of the outcomes of early and delayed discharge strategy after primary PCI in patients with STEMI and to establish the frequency of early discharge following primary PCI in patients having STEMI.
METHODOLOGY: The study was conducted in Cardiology department of Punjab Institute of Cardiology, Lahore from August 10, 2020 to February 10, 2021. Total 200 patients presenting with STEMI were enrolled in the study. Patients underwent primary PCI by a single team with assistance of researcher. If patients were discharged within 36 hours, then earlier discharge was labeled. Patients were asked to present after 1 month in OPD. Patients were advised to present in case they feel similar symptoms of myocardial infarction, stroke, heart failure or mortality. The collected data were analysed statistically by using SPSS v25.0. Both groups were compared using chi-square test for clinical outcome. Data were stratified for age, gender, h/o diabetes, hypertension, smoking and duration of symptoms. Post-stratification, both groups were compared by using chi-square test for clinical outcome in each strata. A p-value ?0.05 was taken as significant.
RESULTS: Total 200 patients presenting with STEMI and underwent primary PCI were enrolled in this study. There were 146(73.0%) were males and 54(27.0%) were females. The mean age of patients was 50.6±19.2 years. Out of 200 patients with STEMI, 86(43.0%) were early discharged and 114(57.0%) had delayed discharged.
CONCLUSION: This study showed that early discharge is also safe and feasible among patients with STEMI who underwent PCI as compared to delayed discharge. Early discharge may help in lowering down healthcare costs for Primary PCI service providers
References
Van der Wall EE. New guidelines on primary PCI for patients with STEMI: changing insights. Neth Heart J. 2016;24(2):93-5.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2016;133(11):1135-47.
Shroff A, Kupfer J, Gilchrist IC, Caputo R, Speiser B, Bertrand OF, et al. Same-Day Discharge After Percutaneous Coronary Intervention: Current Perspectives and Strategies for Implementation. JAMA Cardiol. 2016;1(2):216-23.
Velders MA, James SK, Libungan B, Sarno G, Fröbert O, Carlsson J, et al. Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001 to 2011: A report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry. Am Heart J. 2014;167(5):666-73.
Lim HS, Tonino PA, De Bruyne B, Yong AS, Lee BK, Pijls NH, et al. The impact of age on fractional flow reserve-guided percutaneous coronary intervention: a FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) trial substudy. Int J Cardiol. 2014;177(1):66-70.
Laurencet M-E, Girardin F, Rigamonti F, Bevand A, Meyer P, Carballo D, et al. Early discharge in low-risk patients hospitalized for acute coronary syndromes: feasibility, safety and reasons for prolonged length of stay. PLOS One. 2016;11(8):e0161493.
Melberg T, Jorgensen M, Orn S, Solli T, Edland U, Dickstein K. Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial. Eur J Prevent Cardiol. 2015;22(11):1427-34.
Li S, Li Z, Hou X, Sun J, Kang L, Cheng Y, et al. Safety and cost analysis of early discharge following percutaneous coronary intervention for acute coronary syndrome in patients with diabetes mellitus. J Int Med Res. 2019;47(8):3905-17.
Chotechuang Y, Phrommintikul A, Kuanprasert S, Muenpa R, Patumanond J, Chaichuen T, et al. Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomized trial. Heart Asia. 2019;11(2):011201.
Rosner GF, Kirtane AJ, Genereux P, Lansky AJ, Cristea E, Gersh BJ, Weisz G, Parise H, Fahy M, Mehran R, Stone GW. Impact of the presence and extent of incomplete angiographic revascularization after percutaneous coronary intervention in acute coronary syndromes: the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Circulation. 2012;125(21):2613-20.
Garcia S, Sandoval Y, Roukoz H, Adabag S, Canoniero M, Yannopoulos D, Brilakis ES. Outcomes after complete versus incomplete revascularization of patients with multivessel coronary artery disease: a meta-analysis of 89,883 patients enrolled in randomized clinical trials and observational studies. J Am Coll Cardiol. 2013;62(16):1421-31.
Chambers CE, Dehmer GJ, Cox DA, Harrington RA, Babb JD, Popma JJ, Turco MA, Weiner BH, Tommaso CL. Society for Cardiovascular Angiography and Interventions. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Endorsed by the American College of Cardiology Foundation. Catheter Cardiovasc Interv. 2009;73(7):847-58.
Amin AP, Patterson M, House JA, Giersiefen H, Spertus JA, Baklanov DV, Chhatriwalla AK, Safley DM, Cohen DJ, Rao SV, Marso SP. Costs associated with access site and same-day discharge among Medicare beneficiaries undergoing percutaneous coronary intervention: an evaluation of the current percutaneous coronary intervention care pathways in the United States. JACC: Cardiovascular Interventions. 2017;10(4):342-51.
Seto AH, Shroff A, Abu?Fadel M, Blankenship JC, Boudoulas KD, Cigarroa JE, Dehmer GJ, Feldman DN, Kolansky DM, Lata K, Swaminathan RV. Length of stay following percutaneous coronary intervention: an expert consensus document update from the society for cardiovascular angiography and interventions. Catheterization and Cardiovascular Interventions. 2018;92(4):717-31.
Swaminathan RV, Rao SV, McCoy LA, Kim LK, Minutello RM, Wong SC, Yang DC, Saha-Chaudhuri P, Singh HS, Bergman G, Feldman DN. Hospital length of stay and clinical outcomes in older STEMI patients after primary PCI: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2015;65(12):1161-71.
Abdelnoor M, Andersen JG, Arnesen H, Johansen O. Early discharge compared with ordinary discharge after percutaneous coronary intervention–a systematic review and meta-analysis of safety and cost. Vascular health and risk management. 2017;13:101.
Tripathi A, Abbott JD, Fonarow GC, Khan AR, Barry IV NG, Ikram S, Coram R, Mathew V, Kirtane AJ, Nallamothu BK, Hirsch GA. Thirty-day readmission rate and costs after percutaneous coronary intervention in the United States: a National Readmission Database analysis. Circulation: Cardiovascular Interventions. 2017;10(12):e005925.
Naganuma T, Latib A, Sgueglia GA, Menozzi A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P. A 2-year follow-up of a randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels the BELLO study. Int J Cardiol. 2015;184:17-21.
