Prognostic assessment of patients with acute Myocardial Infarction treated with primary angioplasty: Implications for early discharge

• Published in: Circulation (New York, N.Y.) Vol. 109; no. 22; pp. 2737 - 2743
• Main Authors: DE LUCA, Giuseppe, SURYAPRANATA, Harry, VAN'T HOF, Arnoud W. J, DE BOER, Menko-Jan, HOORNTJE, Jan C. A, DAMBRINK, Jan-Henk E, GOSSELINK, A. T, OTTERVANGER, Jan Paul, ZIJLSTRA, Felix
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 08.06.2004
• Subjects: Aged; Angioplasty; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary heart disease; Costs and Cost Analysis; Diseases of the cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Feasibility Studies; Female; Heart; Humans; Length of Stay - economics; Male; Medical sciences; Middle Aged; Models, Statistical; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Assessment; Human; Myocardial infarction; Prognosis; Treatment; Heart disease; cost-benefit analysis; Cardiovascular disease; Instrumental dilatation; Cost benefit analysis; Myocardial disease; angioplasty
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000131765.73959.87

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. 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. 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.