Very Early Discharge of Patients with ST-Segment-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

Seyed Kianoosh Hosseini; Behshad Naghshtabrizi; Farzad Emami; Amirhossein Yazdi; Nima Naghshtabrizi; Sara Zebarjadi

doi:10.18502/jthc.v16i3.8188

Seyed Kianoosh Hosseini Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Behshad Naghshtabrizi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Farzad Emami Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Amirhossein Yazdi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Nima Naghshtabrizi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Sara Zebarjadi Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran.

DOI: https://doi.org/10.18502/jthc.v16i3.8188

Keywords: Myocardial infarction; Discharge planning; Coronavirus; Percutaneous transluminal coronary angioplasty

Abstract

Background: The discharge of uncomplicated patients with ST-segment-elevation myocardial infarction (STEMI) within 48 to 72 hours has been proven safe and feasible. The safety and feasibility of the very early discharge (≤48 h) of such patients, especially during the COVID-19 pandemic with limited bed availability and infection risk, have yet to be evaluated.

Methods: In this cohort study on 108 patients with STEMI who presented to Farshchian Heart Center between February and May 2020, 30 patients received fibrinolysis and 78 were scheduled for emergent coronary angiography. One patient had no coronary obstruction, 3 underwent emergent surgery, and 3 had high-risk features mandating a prolonged stay. The remaining patients were assigned to either Group A (≤48 h) or Group B (>48 h) regarding hospital discharge. Demographic, angiographic, procedural, and outcome data were compared between the 2 groups.

Results: Group A consisted of 51 patients, including 7 women (13.7%), at a mean age of 62.74±12.35 years, and Group B comprised 20 patients, including 4 women (20.0%), at a mean age of 65.20±12.82 years. The mean hospital length of stay was 38.02±9.15 hours in Group A and 88.20±23.31 hours in Group B (P<0.001). The mean stent diameter was smaller in Group B (3.19±0.34 mm vs 2.96±0.29 mm; P=0.008). Demographic, angiographic, procedural, and outcome data, including the rates of in-hospital, 1-week, and 1-month mortality, were similar between the 2 groups.

Conclusion: This study shows that a hospital discharge in less than 48 hours in low-risk patients with STEMI is safe and feasible. The potential advantages of this approach in the COVID-19 pandemic should be balanced against its risks.