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Canadian Journal of Cardiology

SAFETY AND FEASIBILITY OF VERY EARLY DISCHARGE IN LOW-RISK PATIENTS WITH STEMI AFTER PRIMARY PCI

      Background

      Very early discharge (VED) (≤ 36 hours) for low risk ST segment elevation myocardial infarction (STEMI) patients has been reported in small registries but data on real world clinical outcomes with this approach is limited. We prospectively enrolled low-risk STEMI patients into a VED protocol and compared outcomes with similar patients discharged at 36-72 hours.

      Methods and Results

      Between April 2021- March 2022, 479 patients admitted with STEMI underwent primary PCI (PPCI). Low-risk patients were identified using the University of Ottawa Heart Institute criteria, and after providing informed consent were discharged home 20-36 hours after hospital admission. All patients had telephone follow-up by a nurse practitioner (NP) at 2 days, 7 days and 30 days post discharge. The NP assessed symptoms, and provided education and medication titration. The control group consisted of 82 STEMI patients admitted between 2019-2020 who met the low-risk criteria and were discharged between 36-72 hours as per standard practice. Death, major adverse cardiac events (MACE), re-admissions and ER visits within 30 days were collected for both groups. Additional outcomes which included patients’ satisfaction and experience of the VED protocol were measured by a survey after 30 days. Among the 479 STEMI patients undergoing PPCI during the study period, 27% (n=131) were identified as low risk. Of these, 61% (n=80) were enrolled in the VED protocol. 39% of the patients were not enrolled because study investigator’s unavailability, patients’ repatriation to other hospitals, and physician’s / patients’ preference. All patients were contacted up to 30 days with no loss to follow-up. The median length of stay (LOS) was 27.2 hours (IQR 9.7 hours) for the VED group and 48.2 hours (IQR 11.8 hours) for the control group (p < 0.0001). There were no deaths or MACE in either group. There were no significant differences in the rates of re-admission (p= 0.36) and ER visits (p=0.61). After 30 days, 94% of the VED patients were pleased with the early discharge, 5% wished they could have stayed in hospital longer, 1% was not available to answer survey questions.