PROGNOSTIC IMPLICATIONS OF EARLY DISCHARG E FROM CORONARY UNITS IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Introduction and objectives. The high demand for health care has oblig ed Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objec tive have been: a) to analyse the characteristics and the evolution (d eath or readmission) during the first month of patients with myocardia l infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group p atients for complications who could be discharged early from the Coron ary Unit. Patients and methods. A study of 978 consecutive patients wh o had been admitted for acute myocardial, in faration were divided int o two groups according to their length of stay in the Coronary Unit (A less than or equal to 2 and B > 2 days). Their baseline characteristi cs, course of stay and vital status at month, were compared. A subgrou p of patients at low risk was studied and complications that might hav e arisen from their early discharge from the Coronary Unit were assess ed. Results. Seventy-three patients (7.5%) died within the first two d ays. Of the remaining 905, the stay was 2 days or less for 336 patient s (group A); and longer than 2 days for 569 (group B). Group A had a h igher frequency of dyslipemia, Killip class I on admission, uncomplica ted myocardial infarction in the Coronary Unit and the use of beta-blo ckers and had less frequency of diabetes, Q wave myocardial infarction , anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 1 8 patients from group B died, the rate of death or readmission into th e Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip c lass on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary uni t. A subset of 378 low risk patients (Killip I on admission, uncomplic ated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgrou p, those patients whose stay was equal to or less than two days were m ore frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034). Conclusion. Selected patients wi th myocardial infarction can be discharged very early from the Coronar y Unit with a low risk of death. A readmission rate following discharg e of some 5% must be allowed for these patients.