Safety and cost-effectiveness of early discharge after primary coronary stenting in acute myocardial infarction

Lee, Eun Mi; Oh, Dong Joo; Kang, Young Sun; Ahn, Jeong Cheon; Kim, Young Hoon; Seo, Hong Seog; Shim, Wan Joo; Ro, Young Moo

Abstract

BACKGROUND
Primary coronary stenting results in reduced rates of reinfarction, recurrent ischemia, stroke and in-hospital mortality and may allow earlier hospital discharge compared with primary angioplasty for acute myocardial infarction(AMI). This study evaluated the hypothesis that primary coronary stenting, with subsequent discharge within 4 days after admission, is safe and cost-effective in low risk patients for AMI, prospectively.
METHODS
The study group consisted of low risk patients after susccessful primary stenting with conventional transfemoral intervention for AMI. Low risk status required be met all the following criteria : age< or =75 years, no persistent arrhythmias, no recurrent ischemia and no symptomatic heart failure signs during admission after successful reperfusion. The total 41 patients were randomized into 2 groups{early discharge group(ED, hospital stay < or =4 days), N=25//conventional discharge group(CD, hospital stay > or =5 days), N=16}. Their demographic and angiographic characteristics, the rate of major adverse cardiac events, ejection fraction during 3 months, and total medical costs were analyzed.
RESULTS
The 25 patients(61%) were discharged on day 3 or 4. The peak level of CK-MB were not significantly lower in early discharge group than conventional discharge group(ED/CD;112.4+/-67.3/153.3+/-76.9 U/L, p=0.089). Comparing to conventional discharge group, in-hospital costs were significantly lower in patients of early dicharge group(ED/CD;7,109,118+/-1,068,861/8,766,336+/-1,688,707, p=0.001). Major adverse cardiac events were similar in both group(ED/CD;16/25%, p=0.329).
CONCLUSION
Early identificaton of low risk patients after successful primary stenting by transfemoral intervention for AMI allowed safe omission of the intensive care phase and noninvasive testing, and early hospital discharge, resulting in substantial costs savings.