BACKGROUND: The aim of this study was to create a practical score for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty and to assess the feasibility of early discharge in low-risk patients. METHODS AND RESULTS: A prognostic score was built according to 30-day mortality rates in 1791 patients undergoing primary angioplasty for STEMI. For the identified low-risk patients without any contraindication to early discharge, we estimated and compared the costs of conventional care (prolonged 24-hour hospitalization) with the costs of shifting the care from inpatient to outpatient setting (early discharge) between 48 and 72 hours. Independent predictors of 30-day mortality included in the score were age, anterior infarction, Killip class, ischemic time, postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow, and multivessel disease. This score was able to identify a large cohort (73.4%) of low-risk (score < or =3) patients, with a good discriminatory capacity (c statistic=0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score < or =3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at 1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of 194 933.33, in comparison with an early discharge policy. CONCLUSIONS: This score is a practical and useful index for risk stratification after primary angioplasty for STEMI, with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.
BACKGROUND: The aim of this study was to create a practical score for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty and to assess the feasibility of early discharge in low-risk patients. METHODS AND RESULTS: A prognostic score was built according to 30-day mortality rates in 1791 patients undergoing primary angioplasty for STEMI. For the identified low-risk patients without any contraindication to early discharge, we estimated and compared the costs of conventional care (prolonged 24-hour hospitalization) with the costs of shifting the care from inpatient to outpatient setting (early discharge) between 48 and 72 hours. Independent predictors of 30-day mortality included in the score were age, anterior infarction, Killip class, ischemic time, postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow, and multivessel disease. This score was able to identify a large cohort (73.4%) of low-risk (score < or =3) patients, with a good discriminatory capacity (c statistic=0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score < or =3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at 1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of 194 933.33, in comparison with an early discharge policy. CONCLUSIONS: This score is a practical and useful index for risk stratification after primary angioplasty for STEMI, with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.
Authors: Spyridon Liosis; Timm Bauer; Rudolf Schiele; Helmut Gohlke; Martin Gottwik; Hugo Katus; Georg Sabin; Ralf Zahn; Steffen Schneider; Bernhard Rauch; Jochen Senges; Uwe Zeymer Journal: Clin Res Cardiol Date: 2013-06-06 Impact factor: 5.460
Authors: Joseph E Ebinger; Craig E Strauss; Ross R Garberich; Steven M Bradley; Pam Rush; Ivan J Chavez; Anil K Poulose; Brandon R Porten; Timothy D Henry Journal: Circ Cardiovasc Qual Outcomes Date: 2018-04
Authors: Merril L Knudtson; Colleen M Norris; P Diane Galbraith; Jaro Hubacek; William A Ghali Journal: Can J Cardiol Date: 2009-06 Impact factor: 5.223
Authors: Niels J Verouden; Joost D Haeck; Karel T Koch; José P Henriques; Jan Baan; René J van der Schaaf; Marije M Vis; Ron J Peters; Arthur A Wilde; Jan J Piek; Jan G Tijssen; Robbert J de Winter Journal: Ann Noninvasive Electrocardiol Date: 2010-04 Impact factor: 1.468
Authors: S Kul; H Uyarel; O T Kucukdagli; M Turfan; M A Vatankulu; A Tasal; E Erdogan; E Asoglu; M Sahin; T S Guvenc; O Goktekin Journal: Herz Date: 2014-03-09 Impact factor: 1.443
Authors: Zain Ul Abideen Asad; Safi U Khan; Amod Amritphale; Adhir Shroff; Kusum Lata; Arnold H Seto; Muhammad Shahzeb Khan; Sunil V Rao; Mazen Abu-Fadel Journal: Cardiovasc Revasc Med Date: 2020-05-01