BACKGROUND: Clinical trials suggested feasibility and safety of early discharge after ST-segment elevation acute myocardial infarction (STEMI) for selected patients. Current United States and European guidelines recommend early discharge for uncomplicated AMI. The present study was aimed to assess early discharge in the current clinical practice for STEMI patients. METHODS: Patients enrolled in the AMI-Florence Registry (Italy), a prospective, observational, population-based study performed in the early 2000s, were analysed. The proportion of STEMI patients eligible for early discharge and of those actually discharged early, patient features influencing early discharge and outcomes (mortality, reinfarction or urgent revascularization during the first year of follow-up) were assessed. RESULTS: Of 751 STEMI patients, 59% were classified as eligible for early discharge, according to previously established criteria. Among patients considered eligible, those actually discharged early dropped from 33.1% in age <70 years to 15.9% in age 70-79 years and to 11.7% in age 80+ years. Of eligible patients, 26% were actually discharged within 4 days. Age 70+ years (reference: 69 years or younger; 70-79 years: OR: 0.40, 95% CI: 0.22-0.73; 80+ years: OR: 0.33, 95% CI: 0.14-0.76) and diabetes (OR: 0.48, 95% CI: 0.24-0.98) were negative independent predictors; and coronary reperfusion (OR: 2.92, 95% CI: 1.54-5.53) or firstly admitted to teaching hospital (OR: 1.68, 95% CI: 1.03-2.74) were positive predictors, of the multivariate probability of being early discharged. Among patients eligible for early discharge, 1-year and 3-year mortality did not differ significantly between patients actually, and not, early discharged. After 1 year of follow-up, no deaths were observed among patients early discharged. CONCLUSION: This study confirms, in a setting of current clinical practice, the reliability of criteria for identifying patients eligible for early discharge. Besides, the results confirmed the safety of this practice in selected patients. About 1/4 of eligible patients are actually early discharged, confirming the existence of important opportunities to improve the efficiency in STEMI management.
BACKGROUND: Clinical trials suggested feasibility and safety of early discharge after ST-segment elevation acute myocardial infarction (STEMI) for selected patients. Current United States and European guidelines recommend early discharge for uncomplicated AMI. The present study was aimed to assess early discharge in the current clinical practice for STEMI patients. METHODS:Patients enrolled in the AMI-Florence Registry (Italy), a prospective, observational, population-based study performed in the early 2000s, were analysed. The proportion of STEMI patients eligible for early discharge and of those actually discharged early, patient features influencing early discharge and outcomes (mortality, reinfarction or urgent revascularization during the first year of follow-up) were assessed. RESULTS: Of 751 STEMI patients, 59% were classified as eligible for early discharge, according to previously established criteria. Among patients considered eligible, those actually discharged early dropped from 33.1% in age <70 years to 15.9% in age 70-79 years and to 11.7% in age 80+ years. Of eligible patients, 26% were actually discharged within 4 days. Age 70+ years (reference: 69 years or younger; 70-79 years: OR: 0.40, 95% CI: 0.22-0.73; 80+ years: OR: 0.33, 95% CI: 0.14-0.76) and diabetes (OR: 0.48, 95% CI: 0.24-0.98) were negative independent predictors; and coronary reperfusion (OR: 2.92, 95% CI: 1.54-5.53) or firstly admitted to teaching hospital (OR: 1.68, 95% CI: 1.03-2.74) were positive predictors, of the multivariate probability of being early discharged. Among patients eligible for early discharge, 1-year and 3-year mortality did not differ significantly between patients actually, and not, early discharged. After 1 year of follow-up, no deaths were observed among patients early discharged. CONCLUSION: This study confirms, in a setting of current clinical practice, the reliability of criteria for identifying patients eligible for early discharge. Besides, the results confirmed the safety of this practice in selected patients. About 1/4 of eligible patients are actually early discharged, confirming the existence of important opportunities to improve the efficiency in STEMI management.
Authors: Dirk A A M Schellings; Ahmet Adiyaman; Evangelos Giannitsis; Christian Hamm; Harry Suryapranata; Jurrien M Ten Berg; Jan C A Hoorntje; Arnoud W J Van't Hof Journal: J Am Heart Assoc Date: 2014-11-11 Impact factor: 5.501
Authors: P M Coloma; M de Ridder; I Bezemer; R M C Herings; R Gini; S Pecchioli; L Scotti; P Rijnbeek; M Mosseveld; J van der Lei; G Trifirò; M Sturkenboom Journal: Osteoporos Int Date: 2015-12-22 Impact factor: 4.507
Authors: Marie-Eva Laurencet; François Girardin; Fabio Rigamonti; Anne Bevand; Philippe Meyer; David Carballo; Marco Roffi; Stéphane Noble; François Mach; Baris Gencer Journal: PLoS One Date: 2016-08-23 Impact factor: 3.240
Authors: Preciosa M Coloma; Martijn J Schuemie; Gianluca Trifirò; Laura Furlong; Erik van Mulligen; Anna Bauer-Mehren; Paul Avillach; Jan Kors; Ferran Sanz; Jordi Mestres; José Luis Oliveira; Scott Boyer; Ernst Ahlberg Helgee; Mariam Molokhia; Justin Matthews; David Prieto-Merino; Rosa Gini; Ron Herings; Giampiero Mazzaglia; Gino Picelli; Lorenza Scotti; Lars Pedersen; Johan van der Lei; Miriam Sturkenboom Journal: PLoS One Date: 2013-08-28 Impact factor: 3.240
Authors: D A A M Schellings; A W J van 't Hof; J M Ten Berg; A Elvan; E Giannitsis; C Hamm; H Suryapranata; A Adiyaman Journal: Neth Heart J Date: 2017-04 Impact factor: 2.380