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(Circulation. 2004;109:2737-2743.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Prognostic Assessment of Patients With Acute Myocardial Infarction Treated With Primary Angioplasty

Implications for Early Discharge

Giuseppe De Luca, MD; Harry Suryapranata, MD, PhD; Arnoud W.J. van’t Hof, MD, PhD; Menko-Jan de Boer, MD, PhD; Jan C.A. Hoorntje, MD, PhD; Jan-Henk E. Dambrink, MD, PhD; A.T. Marcel Gosselink, MD, PhD; Jan Paul Ottervanger, MD, PhD; Felix Zijlstra, MD, PhD

From the Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.

Correspondence to Harry Suryapranata, MD, Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Groot Wezeland 20, 8011 JW Zwolle, The Netherlands. E-mail h.suryapranata{at}diagram-zwolle.nl

Received August 5, 2003; de novo received October 1, 2003; revision received February 13, 2004; accepted February 17, 2004.

Background— The aim of this study was to create a practical score for risk stratification in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty and to assess the feasibility of early discharge in low-risk patients.

Methods and Results— A prognostic score was built according to 30-day mortality rates in 1791 patients undergoing primary angioplasty for STEMI. For the identified low-risk patients without any contraindication to early discharge, we estimated and compared the costs of conventional care (prolonged 24-hour hospitalization) with the costs of shifting the care from inpatient to outpatient setting (early discharge) between 48 and 72 hours. Independent predictors of 30-day mortality included in the score were age, anterior infarction, Killip class, ischemic time, postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow, and multivessel disease. This score was able to identify a large cohort (73.4%) of low-risk (score 3) patients, with a good discriminatory capacity (c statistic=0.907). The mortality rate was 0.1% at 2 days and 0.2% between 2 and 10 days in patients with a score 3. The incremental cost-effectiveness ratio for late discharge in low-risk patients was estimated at

1949.33. Therefore, this policy would save 1 life per 1097 low-risk patients, at additional costs of

194 933.33, in comparison with an early discharge policy.

Conclusions— This score is a practical and useful index for risk stratification after primary angioplasty for STEMI, with a significant impact on clinical decision-making and the related costs. It reliably identifies a large group of patients at very low risk, who may safely be discharged early after primary angioplasty.

Key Words: angioplasty • myocardial infarction • prognosis • cost-benefit analysis

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