Early discharge of uncomplicated STEMI patients after successful primary PCI: Enhancing recovery and reducing hospital stay

Background The management of acute coronary syndromes (ACS) continues to present a significant challenge in modern cardiology. Current 2023 European Society of Cardiology (ESC) guidelines [1] recommend early discharge within 48 to 72 hours for low-risk ST-elevation myocardial infarction (STEMI) patients following successful primary percutaneous coronary intervention (pPCI), provided no complications arise and structured follow-up is ensured. However, these recommendations are based on outdated risk scores and limited evidence, highlighting the need for updated, large-scale analyses to validate the safety of early discharge in contemporary clinical practice. Purpose This study aimed to provide real-world evidence on clinical outcomes of early discharge in a contemporary, real-world STEMI population after successful pPCI. Methods A total of 2,399 patients presenting with uncomplicated STEMI undergoing successful pPCI between 2010 and 2021 at a university cardiac catheterization centre were included. Patients were stratified into early (24 - 72 hours), late (72 hours - 14 days) and very late (>14 days) discharge groups. Primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular mortality, recurrent ACS, stroke, or transient ischemic attack (TIA). Secondary endpoints included cardiovascular mortality and recurrent ACS. Risk prediction was performed using multivariate Cox regression analysis. Results In the total study cohort, 291 (12.2%) patients were discharged early, 1,900 (79.2%) late, and 206 (8.6%) very late (distribution curve shown in Figure 1). Baseline characteristics including age, sex, body mass index (BMI), comorbidities, and extent of coronary artery disease were comparable between groups. Early discharge patients, however, had lower SYNTAX scores (8 [5-14] vs. 9 [6-17]; p = 0.007) and shorter intervention durations (55 [41-75] vs. 61 [47-81] minutes; p = 0.001) compared to late discharge patients. During the median follow-up of 5.75 [3.05 - 8.99] years, 105 patients (4.8%) died of cardiovascular causes, 704 (32.1%) developed MACE, and 624 (28.5%) experienced recurrent ACS. Notably, multivariable Cox regression revealed no significant association between discharge timing and cardiovascular mortality or MACE. However, patients discharged early had significantly lower rates of recurrent ACS compared to those discharged late (Table 1). Conclusions Early discharge of carefully selected, uncomplicated STEMI patients following successful pPCI appears safe, without increasing long-term cardiovascular mortality or MACE. These results support current ESC guideline recommendations and emphasize the potential of early discharge to enhance patient recovery, facilitate timely rehabilitation, and optimize hospital resource utilization in modern cardiology. Further studies focusing on contemporary risk sores are needed to enable personalized early discharge strategies.