Prospective, Randomized Trial Evaluating Early Discharge (Day 3) without Non-invasive Risk Stratification in Low Risk Patients with Acute Myocardial Infarction: PAMI-2

Few dat exist regarding the need for noninvasive testing after reperfusion therapy in myocardial patients at low clinical risk. Moreover, after thrombolysis, recurrent ischemi occurs frequently and unpredictably and has resulted in physician reluctance to shorten the length of hospitalization in these patients. Alternatively, emergency catheterization with primary PTC may provide acute determination of risk status, stable method of reperfusion and the potential for early discharge. The objective of this multicenter study was to prospectively test the hypothesis that early discharge (day 3) without non-invasive risk stratification in low risk MI patients treated with primary angioplasty is safe, feasible, and cost effective. Patients with acute myocardial infarction 0-12 hrs who had an emergency catheterization and immediate PTC of the infarct related artery were stratified into low risk group if age ≤70 yrs, 1 or 2 vessel disease, EF > 45%, successful infarct vessel PTC and no malignant arrhythmias persisted after the PTCA. Low risk patients were randomized to admission to either the intensive care unit (with hospitalization minimum of 5 days and predischarge exercise testing) or admission to non-intensive care PTC unit with no non-invasive testing and discharge on day 3. To date, 340 of the anticipated 400 patients have been enrolled. The mean age was 56 ± 9, estimated ejection fraction 56 ± 9 and 74% had single vessel disease. As expected, in-hospital complications occurred infrequently; death 1.1%, recurrent MI 1.7%; stroke 0.6%; heart failure 4.6%. At 1 week follow-up, no complications attributed to early discharge have occurred. Thus, acute catheterization does allow identification of low risk MI patients who can be safely admitted to an elective PTC unit and discharged in 3 days without additional testing. Complete dat on the 400 patient cohort including cost and 6 week follow-up will be available by March 1995.