Hospital discharge after uncomplicated ST elevation acute myocardial infarction: How early is safe?

Abstract

Abstract Background International guidelines recommend that hospital discharge within 48–72h is appropriate in selected low-risk patients admitted for ST elevation acute myocardial infarction (STEMI). Objectives To assess the safety of hospital discharge after 24 hours of admission in patients with uncomplicated STEMI submitted to primary percutaneous coronary intervention (PPCI). Methods We conducted a single-centre retrospective study enrolling consecutive patients admitted for STEMI from 2016 to 2018 submitted to PPCI. We defined clinically uncomplicated STEMI (UMI) as the absence of cardiorespiratory arrest, mechanical complications, tachy- and bradyarrhythmias, heart failure (Killip class > 1 [HF]), reinfarction and types 2 or 3 Bleeding Academic Research Consortium. Additionally, we included the criterion of preserved left preserved ejection fraction (LVEF>50%). Patients referred for coronary surgery (CABG) were excluded. Cumulative rates of death and clinical events defining UMI were reported at days 1, 2, 3, and 4. Death, clinical events defining UMI or repeat coronary revascularization at 1-year were reported after days 1, 2, 3, and 4. Results A total of 356 patients submitted to PPCI were included, with 64±14 years, 73% male. Median in-hospital stay was 4 [3;7] days. Applying UMI criteria we identified 271 patients (76%) in day-1, 249 (70%) in day-2, 244 (69%) in day-3, and 240 (67%) patients in day 4. Using UMI criteria, discharge after day 1 would be associated with 2.0% of early clinical events, 1.6% after day-2, and 1% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was roughly similar after day-2 (Table). Adding LVEF>50% to UMI, we identified 176 patients (49%) in day-1, 168 (47%) in day-2, 165 (46%) in day-3 and 164 (46%) in day-4. Discharge after day 1 would be associated with 1.8% of early clinical events, 0.6% after day-2 and 0.6% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was similar after day-2. Conclusions In our cohort of patients with STEMI submitted to PPCI, clinically uncomplicated criteria identified 69% of patients eligible for safe discharge after day-3. The addition of preserved left ventricular ejection fraction criterion can anticipate a safe discharge after day-2 in almost 50% of patients.