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2009 | 4 | 2 | 212-217
Tytuł artykułu

Feasibility of early hospital discharge directly from coronary care unit after primary angioplasty for uncomplicated acute myocardial infarction

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
Current European and American guidelines recommend early discharge for patients with uncomplicated acute myocardial infarction (AMI). However, this concept has not been widely accepted, and experience with direct discharge from the coronary care unit is limited. We aimed to investigate safety and cost effectiveness of early discharge directly from coronary care unit following successful percutaneous coronary angioplasty (PTCA) in patients with uncomplicated AMI. We included consecutive thirty-one patients with uncomplicated AMI and successful PTCA admitted to coronary care unit of a university hospital. Uncomplicated course was defined as absence of reinfarction, ischemia, VF/VT, repeated PTCA, and heart failure within first 72 hours. Incidence of death, reinfarction, VF/VT, need for revascularisation, and hospitalisation due to heart failure at 1, 6, and 12 months was compared with 56 randomly selected AMI patients with successful PTCA but longer hospitalisation. Average hospital stay was 4 days in early and 6.7 days in control group (p<0.05). Control group had more extensive coronary disease (54% two or more vessels vs. 28% in early discharge, p<0,05). During follow up, none of the early discharged patients died, the only observed event was repeat PTCA due to angina pectoris. In the control group, mortality at 12 months was 3.5% (p<0.05). Cumulative 12 month event free survival was 96% in early discharge group and 87% in control group, but difference was not significant (p=0.15, Cox-Mantel test). Cost reduction of early discharge amounted to 1100 Euro per patient. In conclusions, our study confirmed that for a selected population of patients with AMI, successful PTCA, and uncomplicated clinical course during first 72 hours, discharge as early as three days following the admission is safe.
Wydawca

Czasopismo
Rocznik
Tom
4
Numer
2
Strony
212-217
Opis fizyczny
Daty
wydano
2009-06-01
online
2009-03-27
Twórcy
  • Division of Cardiology, University Clinic of Respiratory and Allergic Diseases, SI-4204, Golnik, Slovenia
  • Department of Cardiology, University Medical Centre, SI-1000, Ljubljana, Slovenia
autor
  • Centre for Intensive Internal Medicine, University Medical Centre, SI-1000, Ljubljana, Slovenia
Bibliografia
  • [1] The task force on the management of acute myocardial infarction of the European Society of Cardiology. Management of acute myocardial infarction in patients presenting with ST-segment elevation, Eur. Heart. J., 2002, 24, 28–66
  • [2] Sans S., Kesteloot H., Kromhout D. on behalf of the Task Force. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on cardiovascular mortality and morbidity statistics in Europe, Eur. Heart. J., 1997, 18, 1231–1248
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  • [4] Antman M.E., Hand M., Armstrong P.W., Bates E.R., Green L.A., Halasyamani L.K., et al., 2007 Update of the ACC/AHA 2004 guidelines for management of patients with acute ST-elevation myocardial infarction, Circulation., 2008, 117, 296–329 http://dx.doi.org/10.1161/CIRCULATIONAHA.107.188209[Crossref]
  • [5] Bassand J.P., Hamm C.W., Ardissino D., Boersma E., Budaj A., Fernandez-Avilez F., et al., Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes, Eur. Heart. J., 2007, 28, 1598–1660 http://dx.doi.org/10.1093/eurheartj/ehm132[Crossref]
  • [6] Weaver W.D., Simes R.J., Betriu A., Grines C.L., Zijlstra F., Garcia E., et al., Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA., 1997, 278, 2093–2098 http://dx.doi.org/10.1001/jama.278.23.2093[Crossref]
  • [7] Mark D.B., Sigmon K., Topol E.J., Kereiakes D.L., Pryor D.B., Candela R.J. et al., Identification of acute myocardial infarction patients suitable for early hospital discharge after aggressive interventional therapy - results from the thrombolysis and angioplasty in acute myocardial infarction registry, Circulation., 1991, 83, 1186–1193
  • [8] Newby L.K., Califf R.M., Guerci A., Weaver W.D., Col J., Horgan J.H., et al., Early discharge in the thrombolytic era: an analysis of criteria for uncompliated infarction from the global utilization of streptokinase and t-PA for occluded coronary arteries (GUSTO) trial, J. Am. Coll. Cardiol., 199,; 27, 625–632
  • [9] Topol E.J., Burek K., O’Neill W.W., Kewman D.G., Kander N.H., Shea M.N., et al., A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion, N. Engl. J. Med., 1988, 318, 1083–1088
  • [10] van der Vlugt M.J., Boersma H., Leenders C.M., Pop G.A., Veerhoek M.J., Simoons M.L., Deckers J.W., Prospective study of early discharge after acute myocardial infarction (SHORT), Eur. Heart. J., 2000, 21, 992–999 http://dx.doi.org/10.1053/euhj.1999.1943[Crossref]
  • [11] Grines C.L., Marsalese D.L., Brodie B., Griffin J., Donohue B., Costantini C.R., et al., Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction, J. Am. Coll. Cardiol., 1998, 31, 967–972 http://dx.doi.org/10.1016/S0735-1097(98)00031-X[Crossref]
  • [12] Hanlon J.T., Coombs D.T., McLellan B.A., Railsback L., Haugen S., Early hospital discharge after direct angioplasty for acute myocardial infarction, Cath. Cardio. Vasc. Diagnosis., 1995, 35, 187–190 http://dx.doi.org/10.1002/ccd.1810350302[Crossref]
  • [13] Senaratne M.P., Irwin M.E., Shaben S., Griffiths J., Nagendran J., Kasza L., et al., Feasibility of direct discharge from the Coronary/Intermediate Care Unit after acute myocardial infarction, J. Am. Coll. Cardiol., 1999, 33, 1040–1046 http://dx.doi.org/10.1016/S0735-1097(98)00682-2[Crossref]
  • [14] Murena E., Molero U., Moio N., Pisani A., Stingone M.A., Guardascione A, et al., Identification of patients with acute myocardial infarction that may be discharged early: prospective evaluation with simple clinical and instrumental indicators, Ital. Heart. J. Suppl., 2001, 2, 775–782
  • [15] Kaul P., Newby L.K., Fu Y., Mark D.B., Califf R.M., Topol E.J., et al., International differences in evolution of early discharge after myocardial infarction, Lancet., 2004, 363, 511–517 http://dx.doi.org/10.1016/S0140-6736(04)15536-0[Crossref]
  • [16] Thygesen K., Alpert J.S., White H.D., ESC/ACCF/ AHA/WHF Joint Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction, J. Am. Coll. Cardiol., 2007, 50, 2173–2195 http://dx.doi.org/10.1016/j.jacc.2007.09.011[Crossref]
  • [17] Wilkinson P., Stevenson R., Ranjadayalan K., Marchant B., Roberts R., Timmins A.D., Early discharge after acute myocardial infarction: risks and benefits, Br. Heart. J., 1995, 74, 71–75 http://dx.doi.org/10.1136/hrt.74.1.71[Crossref]
  • [18] Newby L.K., Eisenstein E.L., Califf R.M., Thompson T.D., Nelson C.L., Peterson E.D., et al., Cost effectiveness of early discharge after uncomplicated acute myocardial infarction, N. Engl. J. Med., 2000, 342, 749–755 http://dx.doi.org/10.1056/NEJM200003163421101[Crossref]
  • [19] Barchielli A., Balzi D., Marchionni N., Carrabba N., Margheri M., Santoro G.M., et al., Early discharge after acute myocardial infarction in the current clinical practice. Community data from the AMIFlorence Registry, Italy, Int. J. Cardiol., 2007,114, 57–63 http://dx.doi.org/10.1016/j.ijcard.2006.01.006[Crossref]
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_s11536-009-0009-6
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