Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis

Figures & data

Figure 1 PRISMA Flow Diagram.

Notes: Adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Creative Commons.¹⁰

Figure 2 Risk of Bias Assessment of RCT Studies.

Notes: Data from these studies.^{7,15,16,20–22,27}

Figure 3 Summary Risk of Bias Assessment of RCT Studies.

Figure 4 Risk of Bias Assessment of Cohort Studies.

Notes: Data from these studies.^{17,19,24–26,28,29}

Figure 5 Summary Risk of Bias Assessment of Cohort Studies.

Table 1 Publication Bias

Test Name	Value	p
Readmission (n=10)
Fail-safe N	0.000	0.355
Rank correlation test (Kendall’s tau)	0.022	1.000
Regression test (Z)	0.451	0.652
Mortality (n=13)
Fail-safe N	12.000	0.012
Rank correlation test (Kendall’s tau)	0.026	0.952
Regression test (Z)	1.305	0.192
LOS (n=6)
Fail-safe N	1314.000	<0.001
Begg and Mazumdar rank correlation	−0.200	0.719
Egger’s regression	−2.484	0.013

Notes: Fail-safe N was calculated using the Rosenthal approach. Data from these studies.^30,31

Figure 6 Forest Plot Outcome of Readmission with Early Discharge vs Standard Discharge.

Figure 7 Forest Plot Outcome of Mortality with Early Discharge vs Standard Discharge of RCT Studies.

Figure 8 Forest Plot Outcome of Mortality with Early Discharge vs Standard Discharge of Cohort Studies.

Figure 9 Forest Plot Outcome of Length of Stay with Early Discharge vs Standard Discharge.

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:1–11.

 Google Scholar

Novobilsky K, Stipa R, Cerny P, et al. Safety of early discharge in low risk patients after acute ST-segment elevation myocardial infarction, treated with primary percutaneous coronary intervention. Open label, randomized trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019;163(1):61–66. doi:10.5507/bp.2018.041

 Web of Science ®Google Scholar

Grines CL, Marsalese DL, Brodie B. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. J Am Coll Cardiol. 1998;31(5):967–972. doi:10.1016/s0735-1097(98)00031-x

 PubMed Web of Science ®Google Scholar

Kotowycz MA, Cosman TL, Tartaglia C, Afzal R, Syal RP, Natarajan MK. Safety and feasibility of early hospital discharge in ST-segment elevation myocardial infarction-A prospective and randomized trial in low-risk primary percutaneous coronary intervention patients (the Safe-Depart Trial). Am Heart J. 2010;159(1):117.e1–117.e6. doi:10.1016/j.ahj.2009.10.024

 Web of Science ®Google Scholar

Azzalini L, Solé E, Sans J, et al. Feasibility and safety of an early discharge strategy after low-risk acute myocardial infarction treated with primary percutaneous coronary intervention: the EDAMI pilot trial. Cardiol. 2015;130(2):120–129. doi:10.1159/000368890

 PubMed Web of Science ®Google Scholar

Swaminathan RV, Rao SV, McCoy LA, et al. Hospital length of stay and clinical outcomes in older STEMI patients after primary PCI: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2015;65(12):1161–1171. doi:10.1016/j.jacc.2015.01.028

 PubMed Web of Science ®Google Scholar

Noman A, Zaman AG, Schechter C, Balasubramaniam K, Das R. Early discharge after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Hear J Acute Cardiovasc Care. 2013;2(3):262–269. doi:10.1177/2048872612475231

 Google Scholar

Rathod KS, Comer K, Casey-Gillman O, et al. Early Hospital Discharge Following PCI for Patients With STEMI. J Am Coll Cardiol. 2021;78(25):2550–2560. doi:10.1016/j.jacc.2021.09.1379

 PubMed Web of Science ®Google Scholar

Jones DA, Rathod KS, Howard JP, et al. Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction. Heart. 2012;98(23):1722–1727. doi:10.1136/heartjnl-2012-302414

 Web of Science ®Google Scholar

Viechtbauer W. Conducting Meta-Analyses in R with the metafor Package. J Stat Softw. 2010;36(3):1–48. doi:10.18637/jss.v036.i03

 Web of Science ®Google Scholar

The jamovi project. Jamovi (Version 2.4) [Computer Software]; 2023.

 Google Scholar