EARLY DISCHARGE IN THE THROMBOLYTIC ERA - AN ANALYSIS OF CRITERIA FORUNCOMPLICATED INFARCTION FROM THE GLOBAL UTILIZATION OF STREPTOKINASEAND T-PA FOR OCCLUDED CORONARY-ARTERIES (GUSTO) TRIAL

Objectives. This study sought to readdress the definition of uncomplic ated myocardial infarction and to apply clinical criteria for early di scharge of such patients in the thrombolytic era. Background. Previous studies proposed early hospital discharge at day 7 to 10 after acute myocardial infarction. The potential for earlier discharge of patients with uncomplicated infarction after thrombolysis remains undemonstrat ed. Methods. We defined ''uncomplicated infarction'' a priori as the a bsence of death, reinfarction, ischemia, stroke, shock, heart failure (Killip class >1), bypass surgery, balloon pumping, emergency catheter ization or cardioversion or defibrillation in the first 4 hospital day s. We applied this definition to 41,021 patients in the Global Utiliza tion of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I ) trial. We examined death at 30 days and 1 year and rates of in-hospi tal reinfarction, heart failure, recurrent ischemia, shock and stroke in the uncomplicated and complicated groups created by application of our definition. We also assessed lengths of hospital and cardiac care unit stay. Results. Application of our clinical criteria yielded 23,49 7 (57.3%) patients in the uncomplicated group at day 4 with a very low risk of death and in-hospital complications: 30-day mortality 1%, rei nfarction 1.7%, heart failure 2.6%, recurrent ischemia 6.7%, shock 0.4 % and stroke 0.2%. One-year mortality was 3.6%. The median hospital st ay was 9 days (7, 12 [25th, 75th percentiles, respectively]), and the median cardiac care unit stay 3 days (3, 5). Conclusions. Simple clini cal characteristics can identify a very low risk post-myocardial infar ction population by hospital day 4. Use of these criteria for early di scharge planning could substantially reduce length of stay for patient s with uncomplicated acute myocardial infarction.