Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: a randomized trial.

Abstract

Early discharge after uncomplicated primary percutaneous coronary intervention (PPCI) is common but the evidence supporting this practice is lacking. We therefore performed a randomized, prospective trial comparing outcomes in low risk PPCI randomized to early discharge or usual care. Over a two years period, all surviving PPCI patients at a single teaching hospital were considered eligible if the Zwolle risk score ≤3. They were randomized to either discharge ≤3 days or usual care. All included patients had routine medical treatment, counselling and follow-up. Health status and all readmissions up to 30 days follow-up were tracked. Of 425 consecutive PPCI patients, 215 (50.6%) were randomized to either early discharge (n = 108) or usual routine discharge (n = 107). The mean index length of stay (LOS) plus the 30 days readmissions length of stay in the early discharge group was lower than in the usual discharge group: 2.7 ± 0.5 days vs 3.0 ± 0.7 days (p = 0.001). During follow-up there were no deaths, and similar readmission rate (4 (3.7%) vs 3 (2.8%), p = 0.69 in the early vs usual discharge group respectively). There was no difference in the 30 days health status measurements. The excluded high-risk group (n = 210) had longer index LOS (total sum 1314 vs 501 days, p = 0.001), and a trend towards more readmissions (10 (4.8%) vs 7 (3.3%) (p = 0.19)). It is feasible and safe to discharge low-risk PPCI patients within three days.