Study Suggests Shorter Driving Restrictions After STEMI, Challenges Outdated Guidelines

Findings from the DRIVE-STEMI study indicate that the risk of death within the first year after hospital discharge remains below 5%, with low incidence rates of cardiac events such as cardiac arrest, syncope, stroke, MI, and hospitalization for rhythm disturbances. The DRIVE-STEMI study was initially presented as a poster at the American College of Cardiology (ACC) 2024 Scientific Session and later published as a research letter in Circulation on January 21, 2025.

The researchers note that several countries, including Canada, the United Kingdom, and Australia, have established guidelines to help medical professionals advise patients on resuming driving after a STEMI. However, in the absence of randomized trials on driving fitness, these recommendations rely largely on observational data from patients with various medical conditions. Suggested waiting periods vary widely, ranging from a few days to four weeks, and many guidelines use sudden cardiac death as a surrogate endpoint.

According to the researchers, the new study is the first to evaluate a composite of clinical outcomes under the term "sudden cardiac incapacitation" as an indicator of driving fitness.

For the study, Luiz F. Ybarra, Western University, London, Canada, and colleagues utilized administrative health databases to establish a cohort of 24,890 STEMI patients (mean age 63 years; 27% women) discharged between April 2017 and March 2021.

The following were the key findings of the study:

• Within the first year, 4.9% of patients died, 0.6% experienced cardiac arrest, 1.7% had syncope, 0.7% suffered a stroke, and 2.7% had a myocardial infarction.
• Hospitalization or emergency department visits occurred in 2.1% of patients for sustained arrhythmia and 0.3% for ventricular tachyarrhythmia.
• Most events took place within the first 15 days after discharge.
• The primary composite endpoint, including death, cardiac arrest, syncope, stroke, MI, and hospitalization or emergency visit for sustained arrhythmia, occurred in 11% of the cohort at one year.
• The secondary composite endpoint, which included death, cardiac arrest, syncope, stroke, or sustained ventricular tachyarrhythmia, was observed in 7.4% of patients.
• Among patients aged 65 or younger, the primary endpoint was seen in 6.7%, compared to 16.8% in those older than 65.
• The secondary endpoint was observed in 3.9% of patients aged 65 or younger and in 12.1% of those over 65.
• The difference between age groups was mainly driven by a higher all-cause mortality rate in older patients (9.1%) compared to younger patients (1.9%), with all comparisons showing statistical significance.

The researchers suggest that the optimal driving restriction period for the entire cohort is one month based on the primary endpoint, while the secondary endpoint indicates a shorter restriction of just two weeks. For younger patients, a two-week restriction may be appropriate according to the primary endpoint, with no restriction needed based on the secondary endpoint.

Since the primary difference between age groups was all-cause mortality, which may have led to an overestimation of sudden cardiovascular incapacitation risk, the researchers believe that the ideal driving restriction for patients over 65 years could be even shorter than the endpoint-based estimates.

Reference:

Singer Z, Wijeysundera HC, Qiu F, et al. Driving restrictions and incapacitation vulnerability evaluation after ST-segment elevation myocardial infarction: DRIVE-STEMI study. Circulation. 2025;151:282-284.