Is it safe to initiate early discharge in patients undergoing coronary intervention for STEMI?

UK: In a new study it was found that selected low-risk patients can be safely discharged after a successful initial PCI using a route supported by an organized, multidisciplinary virtual follow-up program. The findings of this study were published in the Journal of American College of Cardiology on 6th August, 2021.

Regional heart attack services have improved clinical outcomes after ST-segment elevation myocardial infarction (STEMI) by allowing for early reperfusion with primary percutaneous coronary intervention (PCI). Patients appreciate early release after primary PCI, which improves health-care efficiency. 

Krishnaraj S. Rathod and colleagues undertook this study to investigate the safety and feasibility of a novel early hospital release pathway for low-risk STEMI patients. Between March 2020 and June 2021, 600 patients rated low risk for early major adverse cardiovascular events (MACE) were chosen for participation in the route and were released within 48 hours for this study. A cardiac rehabilitation nurse conducted a structured telephone follow-up with patients 48 hours after discharge, and they also had a virtual follow-up at 2, 6, 8, and 12 weeks, as well as at 3 months.

The results stated that:

1. The average length of stay in the hospital was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (pre-pathway median: 65.9 hours [IQR: 48.1-120.2 hours]).

2. All patients were contacted after discharge, and none were missed. During a median follow-up of 271 days (IQR: 88-318 days), there were two deaths (0.33%), both due to coronavirus illness 2019 (>30 days after discharge), with no cardiovascular mortality and 1.2% MACE rates.

3. In both unadjusted and propensity-matched analyses, this finding contrasted well with a previous cohort of 700 patients fitting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%).

4. Because echo tests prior to a short discharge time frame may be limited, 88 percent of patients in this research had left ventriculograms to fulfil LV function assessment metric standards.

5. Furthermore, 23% of patients were scheduled to return for a separate elective outpatient surgery (staged PCI, FFR, CABG).

In conclusion, While patients may appreciate the quicker release, it raises the possibility that some may identify it with a less severe nature of the incident, which may impact their desire to make significant lifestyle adjustments. The researchers also noticed that the quicker release leaves less time in the hospital to discuss secondary preventive strategies and titrate drugs.

Reference:

Rathod, K.S, Comer, K. and Moore, L., 2021. Early Hospital Discharge Following PCI for Patients With STEMI:. [online] Journal of the American College of Cardiology. Available at: [Accessed 16 December 2021] doi/10.1016/j.jacc.2021.09.1379