Following STEMI PCI, discharge after 48 hours as safe as 3 to 4 days

Short hospital stays following PCI may be safe for older patients with STEMI. However, researchers caution stays of less than 48 hours may increase risk for 30-day mortality and major adverse cardiac events (MACE).

Published online in the March 31 issue of the Journal of the American College of Cardiology, Rajesh V. Swaminathan, MD, of New York-Presbyterian Hospital in New York City, and colleagues analyzed linked data from the CathPCI registry and Centers for Medicare & Medicaid Services between 2004 and 2009. Their focus was on patients who were 65 years or older who underwent PCI for STEMI. Of 33,920 patients, they found three categories of length of stay: short stays of up to three days, medium stays between four and five days, and long stays, which lasted more than five days. They also performed a subanalysis of patients who had very short stays of less than 48 hours.

Reviewing outcomes, they found that between patients with short and medium length stays, there was no significant difference in 30-day all-cause mortality or MACE. When comparing long vs. short stays, risk was more than two times greater for unadjusted mortality (hazard ratio 2.3) and three-quarters more for MACE (1.75).

However, they also saw a U-shaped curve for risk of mortality or MACE when patients with very short stays were part of the analysis. Stays of three to four days were associated with 50 percent less mortality and 40 percent fewer MACE episodes than patients whose stays were under 48 hours.

For patients with STEMI, it appeared to be safest to release patients from the hospital as early as 48 hours to as late as four days after PCI. Beyond that in either direction, rates of MACE and mortality were dramatically increased.

These findings were in line with several early discharge studies published recently, including one on transcatheter aortic valve replacements and another looking at patients with acute chest pain.

A commentary included in the same issue, Frederic S. Resnic, MD, and Sachin P. Shah, MD, from Lahey Hospital and Medical Center in Burlington, Mass., noted that this observational study was also significant for the findings of geographic and hospital-related variation affecting length of stay. “Smaller hospitals and those in the West and Midwest regions of the United States were much more likely to have a short length of stay,” they wrote.

“The paper by Swaminathan et al. helps affirm that the current practice to discharge lower-risk patients early ([less than or equal to] 3 days) is likely as safe as longer hospital stays. Given the observed geographic variation, there is probably an opportunity to apply this practice more broadly, there by achieving significant health care cost savings while maintaining the quality of STEMI care.”