The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients.
In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay.
Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate.
Low risk patients (age <=70 years, left ventricular ejection fraction>45%, one-or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [n=237] or traditional care [n=234]). Results.
Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4.2 ± 2.3 vs. 7.1 ± 4.7 days, p=0.0001) and had lower hospital costs ($9,658 ± 5,287 vs. $11,604 ± 6,125 p=0.002) than the patients who received traditional care.
At 6 months, accelerated and traditional care groups had a similar rate of mortality (0.8% vs. 0.4%, p=1.00), unstable ischemia (10.1% vs. 12.0%, p=0.52), reinfarction (0.8% vs. 0.4%, p=1.00), stroke (0.4% vs. 2.6%, p=0.07), congestive heart failure (4.6% vs. 4.3%, p=0.85) or their combined occurrence. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Dilatation instrumentale, Artère coronaire, Analyse coût efficacité, Economie santé, Sortie hôpital, Précoce, Etude longitudinale, Traitement, Pronostic, Survie, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Traitement instrumental
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Instrumental dilatation, Coronary artery, Cost efficiency analysis, Health economy, Hospital discharge, Early, Follow up study, Treatment, Prognosis, Survival, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0243523
Code Inist : 002B12A03. Création : 11/09/1998.