Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

Jehangir Ali Shah; Tahir Saghir; Bashir Ahmed; Syed Alishan ul Haq; Rajesh Kumar; Muhammad Naeem Mengal; Mehwish Zehra; Syeda Sakeena Raza; Musa Karim; Nadeem Qamar

doi:10.5334/gh.1035

Safety and Feasibility of Same Day Discharge Strategy for Primary Percutaneous Coronary Intervention

Volume 16 (2021): Issue 1

By: Jehangir Ali Shah, Tahir Saghir, Bashir Ahmed, Syed Alishan ul Haq, Rajesh Kumar, Muhammad Naeem Mengal, Mehwish Zehra, Syeda Sakeena Raza, Musa Karim and Nadeem Qamar

Open Access

|Jul 2021

Figures & Tables

Table 1

Baseline characteristics, angiographic findings, procedural characteristics, and post procedure complications stratified by discharge time.

Characteristics	Total	Discharge after Primary PCI		P-value
Characteristics	Total	Very Early(≤ 24 hours)	Early(24 to 48 hours)	P-value
Total (N)	600	504	96	–
Gender
Male	81.8% (491)	83.1% (419)	75% (72)	0.058
Female	18.2% (109)	16.9% (85)	25% (24)
Age (years)	54.89 ± 11.08	54.63 ± 10.84	56.23 ± 12.23	0.195
≤ 45 years	21% (126)	21.2% (107)	19.8% (19)	0.230
46 to 65 years	63% (378)	63.9% (322)	58.3% (56)	0.230
> 65 years	16% (96)	14.9% (75)	21.9% (21)
Killip class
I	90% (540)	91.5% (461)	82.3% (79)	0.006*
II	10% (60)	8.5% (43)	17.7% (17)
Duration of CP (minutes)	270 [150–450]	270 [150–448]	300 [145–570]	0.311
Type of myocardial infarction
Anterior	51.8% (311)	53% (267)	45.8% (44)	0.435
Inferior	41.5% (249)	40.5% (204)	46.9% (45)	0.435
Posterior	4.7% (28)	4.4% (22)	6.3% (6)
Lateral	2% (12)	2.2% (11)	1% (1)
Co-morbid conditions
Hypertension	52.5% (315)	50.4% (254)	63.5% (61)	0.018*
Diabetes	37.2% (223)	36.7% (185)	39.6% (38)	0.593
Family history of CAD	4.5% (27)	4.6% (23)	4.2% (4)	0.864
Smoking	32.7% (196)	34.3% (173)	24% (23)	0.047*
Obesity	4.3% (26)	4.6% (23)	3.1% (3)	0.526
Access for the procedure
Radial	47.5% (285)	50% (252)	34.4% (33)	0.005*
Femoral	52.5% (315)	50% (252)	65.6% (63)
Number of vessels involved
Single vessel disease	22.8% (137)	23.6% (119)	18.8% (18)	0.066
Two vessels disease	36.8% (221)	38.1% (192)	30.2% (29)	0.066
Three vessels disease	40.3% (242)	38.3% (193)	51% (49)
Culprit coronary artery
Left main	1.7% (10)	1.8% (9)	1% (1)	0.513
LAD	55.7% (334)	56.9% (287)	49% (47)
RCA	29.5% (177)	28% (141)	37.5% (36)
LCX	11.5% (69)	11.5% (58)	11.5% (11)
Ramus	1.2% (7)	1.2% (6)	1% (1)
Diagonal	0.5% (3)	0.6% (3)	0% (0)
TIMI (pre-procedure) flow grade
0	52.2% (313)	49.4% (249)	66.7% (64)	0.010*
I	40.7% (244)	42.5% (214)	31.3% (30)	0.010*
II	4.5% (27)	5.2% (26)	1% (1)
III	2.7% (16)	3% (15)	1% (1)
TIMI (post-procedure) flow grade
0	1% (6)	1% (5)	1.1% (1)	<0.001*
I	0.5% (3)	0.2% (1)	2.1% (2)	<0.001*
II	17.5% (103)	14.3% (71)	34% (32)
III	81% (477)	84.4% (418)	62.8% (59)
Complication(s)/outcomes
Total	2% (12)	0.8% (4)	8.3% (8)	<0.001*
Contrast-induced nephropathy (CIN)	16.7% (2)	0% (0)	25% (2)	0.001*
Major bleeding	16.7% (2)	25% (1)	12.5% (1)	0.189
Ventricular tachycardia	16.7% (2)	25% (1)	12.5% (1)	0.189
Cardiac arrest	16.7% (2)	0% (0)	25% (2)	0.001*
Dissection	16.7% (2)	25% (1)	12.5% (1)	0.189
Others	16.7% (2)	25% (1)	12.5% (1)	0.189

[i] * Significant at 5%.

PCI = percutaneous coronary intervention; CP = chest pain; CAD = coronary artery diseases; LAD = left anterior descending artery; RCA = right coronary artery; LCX = left circumflex artery; TIMI = thrombolysis in myocardial infarction.

Table 2

Post-procedure 7-day and 30-day follow-up outcomes stratified by discharge time.

Outcomes	Total	Discharge after Primary PCI		P-value
Outcomes	Total	Very Early (≤ 24 hours)	Early (24 to 48 hours)	P-value
Total (N)	600	504	96	–
Outcomes after 7-days
Loss to follow-up	4% (24)	3% (15)	9.4% (9)	–
Total (N) at 7-day follow-up	576	489	87	–
MACE	3.5% (20)	3.7% (18)	2.3% (2)	0.516
All-cause death	1.4% (8)	1.6% (8)	0% (0)	0.230
Myocardial infarction	0.3% (2)	0.4% (2)	0% (0)	0.550
Bleeding events	0.5% (3)	0.6% (3)	0% (0)	0.464
Cerebrovascular events	0.9% (5)	0.8% (4)	1.1% (1)	0.759
Hospitalization for unstable angina	0.5% (3)	0.4% (2)	1.1% (1)	0.377
Unplanned coronary revascularization	0.9% (5)	1% (5)	0% (0)	0.343
Outcomes after 30 days
Loss to follow-up	4.3% (26)	3.4% (17)	9.4% (9)	–
Total (N) at 30-day follow-up	574	487	87	–
MACE	4.9% (28)	5.1% (25)	3.4% (3)	0.501
All-cause death	2.3% (13)	2.5% (12)	1.1% (1)	0.448
Myocardial infarction	0.5% (3)	0.6% (3)	0% (0)	0.463
Bleeding events	0.5% (3)	0.6% (3)	0% (0)	0.463
Cerebrovascular events	1.4% (8)	1.4% (7)	1.1% (1)	0.833
Hospitalization for unstable angina	0.5% (3)	0.4% (2)	1.1% (1)	0.379
Unplanned coronary revascularization	1.2% (7)	1.4% (7)	0% (0)	0.261

[i] * Significant at 5%.

PCI = percutaneous coronary intervention; MACE = major adverse cardiac event.

Table 3

Post-procedure 7-day and 30-day follow-up outcomes stratified by Zwolle risk score (ZRS).

Outcomes	Total	Zwolle risk score (ZRS)		p-value
Outcomes	Total	Low-risk (≤ 3)	High-risk (≥ 4)	p-value
Total (N)	600	491	109	–
Outcomes after 7-days
Loss to follow-up	4% (24)	3.9% (19)	4.6% (5)	–
Total (N) at 7-day follow-up	576	472	104	–
MACE	3.5% (20)	3.6% (17)	2.9% (3)	0.718
All-cause death	1.4% (8)	1.5% (7)	1% (1)	0.681
Myocardial infarction	0.3% (2)	0.4% (2)	0% (0)	0.506
Bleeding events	0.5% (3)	0.6% (3)	0% (0)	0.415
Cerebrovascular events	0.9% (5)	0.8% (4)	1% (1)	0.910
Hospitalization for unstable angina	0.5% (3)	0.6% (3)	0% (0)	0.415
Unplanned coronary revascularization	0.9% (5)	0.8% (4)	1% (1)	0.910
Outcomes after 30 days
Loss to follow-up	4.3% (26)	4.3% (21)	4.6% (5)	–
Total (N) at 30-day follow-up	574	470	104	–
MACE	4.9% (28)	4.7% (22)	5.8% (6)	0.641
All-cause death	2.3% (13)	1.9% (9)	3.8% (4)	0.231
Myocardial infarction	0.5% (3)	0.4% (2)	1% (1)	0.493
Bleeding events	0.3% (2)	0.4% (2)	0% (0)	0.505
Cerebrovascular events	1.4% (8)	1.5% (7)	1% (1)	0.678
Hospitalization for unstable angina	0.5% (3)	0.6% (3)	0% (0)	0.414
Unplanned coronary revascularization	1.2% (7)	1.3% (6)	1% (1)	0.791

[i] MACE = major adverse cardiac event.

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DOI: https://doi.org/10.5334/gh.1035 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Mar 18, 2021

Accepted on: Jun 15, 2021

Published on: Jul 1, 2021

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

coronary artery disease,

ST-segment elevation myocardial infarction,

primary percutaneous coronary intervention,

early discharge,

major adverse cardiac events

© 2021 Jehangir Ali Shah, Tahir Saghir, Bashir Ahmed, Syed Alishan ul Haq, Rajesh Kumar, Muhammad Naeem Mengal, Mehwish Zehra, Syeda Sakeena Raza, Musa Karim, Nadeem Qamar, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2021): Issue 1