Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Praneed Songwathana
{"title":"原发性经皮冠状动脉介入术后低风险患者提前出院的安全性：最新系统回顾和元分析","authors":"Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Praneed Songwathana","doi":"10.2147/tcrm.s451598","DOIUrl":null,"url":null,"abstract":"<strong>Background:</strong> Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant.<br/><strong>Purpose:</strong> This study aims to identify the safety of early discharge after PPCI in low-risk patients<br/><strong>Methods:</strong> The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI’s and Cochrane’s Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0.<br/><strong>Results:</strong> Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD − 0.01; 95% CI: − 0.04 to 0.01; Z=1.20; <em>p</em>=0.23; I<sup>2</sup>=0%) and mortality (RD 0.00; 95% CI: − 0.01 to 0.01; Z=0.01; <em>p</em>=0.99; I<sup>2</sup>=0%) and also significant in reducing LOS in hour (SMD − 2.32; 95% CI: − 3.13 to − 1.51; Z=5.64; <em>p</em>< 0.001; I<sup>2</sup>=93%) and day (SMD − 0.58; 95% CI: - 1.00 to − 0.17; Z=2.76; <em>p</em>=0.006; I<sup>2</sup>=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD − 0.00; 95% CI: − 0.01 to − 0.00; Z =2.18; <em>p</em>=0.03; I<sup>2</sup>=0%) and mortality (RD − 0.01; 95% CI: − 0.02 to − 0.00; Z=2.04; <em>p</em>=0.04; I<sup>2</sup>=94%).<br/><strong>Conclusion:</strong> ED strategies in low-risk patients after PPCI can be completely safe. This is proven by the absence of significant differences in readmission and mortality rates as well as reduce the length of stay.<br/><br/>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis\",\"authors\":\"Firman Sugiharto, Yanny Trisyani, Aan Nuraeni, Praneed Songwathana\",\"doi\":\"10.2147/tcrm.s451598\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<strong>Background:</strong> Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant.<br/><strong>Purpose:</strong> This study aims to identify the safety of early discharge after PPCI in low-risk patients<br/><strong>Methods:</strong> The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI’s and Cochrane’s Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0.<br/><strong>Results:</strong> Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD − 0.01; 95% CI: − 0.04 to 0.01; Z=1.20; <em>p</em>=0.23; I<sup>2</sup>=0%) and mortality (RD 0.00; 95% CI: − 0.01 to 0.01; Z=0.01; <em>p</em>=0.99; I<sup>2</sup>=0%) and also significant in reducing LOS in hour (SMD − 2.32; 95% CI: − 3.13 to − 1.51; Z=5.64; <em>p</em>< 0.001; I<sup>2</sup>=93%) and day (SMD − 0.58; 95% CI: - 1.00 to − 0.17; Z=2.76; <em>p</em>=0.006; I<sup>2</sup>=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD − 0.00; 95% CI: − 0.01 to − 0.00; Z =2.18; <em>p</em>=0.03; I<sup>2</sup>=0%) and mortality (RD − 0.01; 95% CI: − 0.02 to − 0.00; Z=2.04; <em>p</em>=0.04; I<sup>2</sup>=94%).<br/><strong>Conclusion:</strong> ED strategies in low-risk patients after PPCI can be completely safe. 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Safety of Early Discharge Among Low-Risk Patients After Primary Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis
Background: Guidelines for early discharge (ED) strategies after primary percutaneous coronary intervention (PPCI) in low-risk patients still need to be informed. Previous meta-analysis evidence is considered to have limitations, from the level of heterogeneity, which is still relatively high, and the sample size still needed to be more significant. Purpose: This study aims to identify the safety of early discharge after PPCI in low-risk patients Methods: The literature search used five primary databases: CINAHL, PubMed, ScienceDirect, Scopus, Taylor and Francis, and one search engine: Google Scholar. Two reviewers independently screened and critically appraised studies using JBI’s and Cochrane’s Risk of Bias tool. Fixed and random effects model were applied to collect standardized mean differences and risk differences. Statistical analysis was performed using Review Manager 5.3 and JAMOVI version 2.4.8.0. Results: Seven RCTs consisting of 1.780 patients and seven cohort studies consisting of 46.710 patients were included in the quantitative analysis. The results of the RCT analysis showed no significant differences in all-cause readmission (RD − 0.01; 95% CI: − 0.04 to 0.01; Z=1.20; p=0.23; I2=0%) and mortality (RD 0.00; 95% CI: − 0.01 to 0.01; Z=0.01; p=0.99; I2=0%) and also significant in reducing LOS in hour (SMD − 2.32; 95% CI: − 3.13 to − 1.51; Z=5.64; p< 0.001; I2=93%) and day (SMD − 0.58; 95% CI: - 1.00 to − 0.17; Z=2.76; p=0.006; I2=84%). In addition, analysis of cohort studies showed that ED strategy was associated with all-cause readmission (RD − 0.00; 95% CI: − 0.01 to − 0.00; Z =2.18; p=0.03; I2=0%) and mortality (RD − 0.01; 95% CI: − 0.02 to − 0.00; Z=2.04; p=0.04; I2=94%). Conclusion: ED strategies in low-risk patients after PPCI can be completely safe. This is proven by the absence of significant differences in readmission and mortality rates as well as reduce the length of stay.
期刊介绍：
Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas.
The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature.
As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication.
The journal does not accept study protocols, animal-based or cell line-based studies.
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