Author + information
- Amit Taneja1,
- Sadeek Kanoun2,
- Venk Suresh1,
- Ian Lines1,
- Cherith Wood1,
- Sivasankar Sangaraju1 and
- Girish Viswanathan1
Primary PCI is the standard treatment for STEMI and has reduced mortality and hospital stay. We evaluated outcomes and arrhythmia burden of patients discharged very early after their PPCI (within 48 hours).
We enrolled 71 consecutive patients who underwent successful PPCI in a tertiary center. After excluding those who needed ICU care, staged revascularization, IABP, cardiac arrest, and procedural complications, 44 were included in the study. All underwent ambulatory ECG monitoring prior to discharge for at least 24 hours, and detailed rhythm analysis was done by physiologists blinded to the discharge status. Patients were divided into ED, early discharge group (within 48 hours), and RD, routine discharge group (after 48 hours), and were followed up for 18 months.
The mean age was 65.7 years (±SD12.1) and 55% were men. One-third of the patients were smokers and 17% were diabetics. Inferior MI was diagnosed in half, and all were treated with DES (mean number of stents 1.7±0.9). Radial access was used in 89% of cases, and 100% had immediate procedure success with restoration of TIMI 3 flow. All were treated with aspirin and prasugrel as per AHA/ACC/ESC guidelines. Median duration of hospital stay was 72 hours and 34.1% (n=15) were discharged within 48 hours (ED group). Higher proportion of patients in the ED group were men (73.3% vs. 48.3%, p=0.112), current smokers (80.0% vs. 29.4%, p=0.001), younger (mean±SD, in years, 55.5±7.5 vs. 70.7±11.4, p=0.001) and had better renal function (eGFR, mean±SD, mmol/l, 85.6±11.2 vs. 74.2±11.2, p=0.045). There were no differences in CV risk factors, vitals at admission, door to balloon time, peak troponin levels, left ventricular ejection fraction(53.5±8.5 vs. 47.3±9.4, p=0.680), between both groups.
Cardiac rhythm analysis showed numerically higher mean heart rates in ED group (mean±SD, beats per minute, 66.1±9.9 vs. 73.1±11.7, p=0.060). No patient had life-threatening arrhythmia, 5 had transient AF (2 ED), 1 had transient second-degree AV block, 2 had <3 sec asymptomatic pauses (1 ED) and 3 had NSVT (1 ED). There was no difference in overall arrhythmia burden between both the groups. At 18-month follow-up, 2 patients died (overall 4.5%, both in RD group, p=0.541), 1 had TVR (RD group, 3.4%) and 1 had TLR (ED group, 6.7%).
We have shown that significant arrhythmias are rare after PPCI, and discharge within 48 hours is a safe strategy after successful PPCI. If confirmed in large-scale multicentre trials, our findings may have significant implications on health-care resources and costs.