Introduction Early reperfusion therapy of acute myocardial infarction (AMI) has decreased hospital stay. We hypothesized that pts receiving early primary percutaneous coronary intervention (PCI) could be safely discharged on hospital day 3.
Methods We reviewed the records of all pts with AMI admitted to the University of Kansas Hospital from 3/2003-4/2004. With admission day as Day 0, we noted the day of occurrence of each event which required hospital care for prevention or treatment, including sustained ventricular tachycardia (VT), atrial fibrillation (AF), intra-aortic balloon pump (IABP), symptomatic hypotension (LBP), AV block (AVB), shock, heart failure (CHF), ventilator support (Vent), recurrent ischemia (Isch), AMI, stroke, and death.
Results Of 570 AMI pts, 408 were admitted>12 hours after onset. The remaining 162 pts, all with successful PCI, were aged 59 ± 13 years and 82% were male. ST elevation AMI occurred in 86% with inferior location in 57% and anterior in 37%. TIMI score was 3.1 ± 2.0. Time from hospital arrival to cardiac catheterization was 109 ± 80 minutes. One hundred thirty-one events (range 1-7) occurred in 73 pts (45%) while 89 pts experienced no events. (Table)
Ninety-eight percent of events occurred on Days 0-3. All 3 pts with later events also had events on Day 0. In a multivariate model, only EF was a significant predictor of events, p=0.04. Of pts with EF < 40%, 16% had events vs 8% with EF ≥ 40%, p < 0.005. The 3 pts with events after Day 3 had EF 40-43%.
Conclusion It is safe to discharge AMI pts after hospital Day 3, if they had successful primary PCI and have not experienced complications during Days 0-3. While EF predicts overall events, it is an imperfect tool for discharge planning.