Early discharge (<3 days) following primary PCI is safe in low risk patients

Abstract

Background: Previous studies suggest that patients may be discharged early following hospitalization with STEMI treated by primary PCI (pPCI) and an uncomplicated clinical course. However, there is concern that early may place patients at risk, and there is little prospective data to support such a practice. The aim of this study was to assess patient safety in low-risk patients discharged from hospital within 3 days following pPCI. Methods: A total of 425 consecutive STEMI patients admitted for primary pPCI at a single center during a 2 year period were included in this prospective study. Patients were assessed using the Zwolle score. The Zwolle score is validated to identify low-risk STEMI patients for early and takes into account age, 3-vessel disease, Killip Class, anterior infarction and TIMI flow post PCI. Patients with a Zwolle score <4 were considered Low-risk and randomized into 2 groups: Early discharge (within 3 days) and Routine discharge. Patients that were not randomized were included in a registry as a High-risk reference. Patient safety was evaluated against all- cause mortality and major adverse cardiovascular events (MACE) during long-term follow-up (median 466 days). Results: From the 425 consecutive patients assessed, a total of 215 patients (50.6%) were defined as Low-risk. From these patients 108 patients were randomized to Early discharge and 107 patients to Routine discharge. Among the remaining patients that were not randomized (High n=210), the most common reasons for exclusion were: Zwolle score >4: 67% (n=161), complicated clinical course: 41% (n=87), transfer to other hospital: 15% (n=36) and refusal to be randomized: 8.6% (18). The Low-risk patients spent less time in hospital during index hospitalization compared with High-risk patients: 501 vs. 1314 days (p<0.001). Early discharge patients spent less time in hospital during index hospitalization than Routine discharge patients: 239 vs. 262 days (p<0.001). During follow-up, there were no differences in mortality, MACE or hospital readmissions between Early discharge and Routine discharge groups. Comparing outcomes during follow-up in High-risk and Low-risk patients: there were no deaths in the Low risk group, one death in the High-risk group. There were more patients with MACE (6.2% vs. 3.7%, p=0.25), and significantly more heart failure hospitalizations (7.6% vs. 0.9%, p=0.001) in High-risk patients. Conclusions: This prospective study suggests that early (<3 days) after pPCI is safe in low-risk patients with a Zwolle score <4.