FEASIBILITY OF EARLY DISCHARGE AFTER ACUTE Q-WAVE MYOCARDIAL-INFARCTION IN PATIENTS NOT RECEIVING THROMBOLYTIC TREATMENT

Objectives. The purpose of this study was to analyze the feasibility o f early discharge (4 days) after acute myocardial infarction in patien ts not receiving thrombolytic therapy by first identifying predictors of short-term prognosis and then testing the derived risk profile in a n independent cohort of patients. Background. Previous studies have sh own that early discharge after acute myocardial infarction is possible . However, physicians are reluctant to shorten the standard 7- to 10-d ay hospital stay, presumably because of difficulty in selecting low ri sk patients. Methods. From January 1985 to November 1986, 358 patients with acute myocardial infarction who did not receive thrombolytic the rapy were screened. Those with a Q-wave infarction showing no complica tions on day 4 were considered candidates for early discharge and were transferred to the ward for a mean of 12 days. During this period, we looked for any event (cardiac or noncardiac) that would have prompted readmission if the patient had been previously discharged. Univariate and multiple regression analysis were performed to identify predictor s of these events among 25 baseline variables. The derived risk profil e was tested in an independent validation cohort. Results. One hundred five (29.3%) of the 358 patients were free of symptoms on day 4, and 29 (27.6%) had at least one cardiac event, including four deaths and o ne reinfarction. Multivariate analysis selected diabetes, ejection fra ction <40% and age as independent predictors of events. Using the risk profile, 18 (13.2%) of the 136 validation cohort patients were catego rized as low risk, and only I of them had a major event (progressive a ngina). Sensitivity for the risk profile was high (91%), but specifici ty was low (34%). Conclusions. The use of simple clinical variables ma y allow the safe reduction of hospital stay after infarction in select ed patients. However because the proportion of candidates for early di scharge is small (12.6%), it seems unlikely that the current policies on length of hospital stay will change in the near future.