Very Early Discharge of LOw-Risk ST Elevation MI patients after successful primary percutaneous coronary intervention (VEDLOR-STEMI) study

Abstract

Abstract Background Current European guidelines recommend discharging low-risk STEMI patients after successful primary PCI at 48-72 hours, based on meta-analysis and large observational studies. There is overall trend towards reducing hospital stay after the COVID-19 pandemic with the risk of cross-infection and to reduce the strain on bed capacity in hospitals. Purpose With this background, we decided to create a pathway to implement very early discharge (within 48 hours) of low-risk STEMI patients after successful primary PCI. The aim of this study is to assess the feasibility and safety of this approach in our centre. Methods This is a single arm, open label prospective observational study of patients undergoing primary PCI in a single high volume tertiary cardiac center. The inclusion criteria included patients ≤70 years with STEMI presenting within 12 hours of symptom onset, one or two vessel disease (>50% stenosis) who underwent successful primary PCI with TIMI 3 flow with LVEF of ≥45% after 24 hrs. Patients with persistent arrhythmia after PCI, recurrent ischemic symptoms, severe anaemia (Hb ≤7 g/dl), eGFR ≤ 45ml/min/1.73 m2 and cardiogenic shock were excluded. We created specific pathways to identify and implement the very early discharge protocol (within 48 hours) in these patients with regular telephone follow up (1st and 3rd post-discharge days) and direct clinic visit at 1 week and after 1 month. The primary outcome of the study was major adverse cardiovascular event at 1 week and 30 days after discharge. Secondary outcome included patient’s satisfaction on early discharge. Results From Mar 2021 to Dec 2022, 84 [mean age 55 ± 9 yrs, 16 (18.2%) females] out of 106 patients provided informed consent to be included in the study. Diabetes, Hypertension, Dyslipidemia, and smoking history were noted in 46 (52.2%), 39 (44.3%), 41 (46.5%) and 6 (6.8%) patients respectively. Mean LVEF was 50±5% after 24 hours of primary PCI. The procedural characteristics of the patients are provided in Table 1. Five patients (5.7%) had minor complictions post discharge; 2 had access site pain, one had giddiness due to hypotension, one had chest pain post discharge, and another had allergic reaction. All of them were managed without the need for re-admission. At one week follow up, except for 2 patients, all others (98%) were satisfied with this early discharge protocol. There was no major adverse cardiac event at 1 week and 30 days. Conclusion This single centre study shows that very early discharge (within 48 hrs) of low-risk STEMI patients after successful primary PCI is feasible and safe with appropriate discharge pathway and follow-up arrangements. Larger studies are needed to confirm this finding.