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Rathod KS, Comer K, Casey-Gillman O, Moore L, Mills G, Ferguson G, Antoniou S, Patel R, Fhadil S, Damani T, Wright P, Ozkor M, Das D, Guttmann OP, Baumbach A, Archbold RA, Wragg A, Jain AK, Choudry FA, Mathur A, Jones DA. Early Hospital Discharge Following PCI for Patients With STEMI. J Am Coll Cardiol 2021; 78:2550-2560. [PMID: 34915986 DOI: 10.1016/j.jacc.2021.09.1379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care. OBJECTIVES This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients. METHODS Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months. RESULTS The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses. CONCLUSIONS Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.
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Affiliation(s)
- Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Casey-Gillman
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Lizzie Moore
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Gordon Mills
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Gordon Ferguson
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Riyaz Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Sadeer Fhadil
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Tasleem Damani
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mick Ozkor
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Debashish Das
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Oliver P Guttmann
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - R Andrew Archbold
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ajay K Jain
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Fizzah A Choudry
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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