Outcome of Very Early Discharge after ST Segment Elevation Myocardial Infarction (EDIPOS Trial)

Background: Current Guidelines after STEMI recommend hospitalization of 2-3 days in ICCU Unit and additional days in Non-ICU. However in selected low risk patients an early hospital discharge is reasonable after 72 hours. We assess the outcome of discharge within 72 hours.

Method: We conducted a retrospective cohort study. Data was collected from January 2012 to December 2015. Patients were classified into 3 Groups according to length of hospitalization; 48 hours, 48-72 hours and more than 72 hours. Primary end points were; all-cause mortality and major cardiovascular events (MACE) within 30 days and 1 year. Secondary endpoint includes renal insufficiency.

Results: 178 Patients were Included. 60 patients (33.7%) were discharged within 48 hours (<48h), 75 patients (42.1%) discharged after 72 hours (>72h) and the remaining 43 (24.2%) discharged between 48 and 72 hours (48-72h). Patients released >72h were statistically significant older (p<.001). The prevalence of females was higher in the >72h group (p<0.02). There were a significant difference in 1 year MACE events between the 3 groups with 72 hour group (p<.01). Survival time, either 30 days or 1 year were higher in the >72h group but not statistically significant different (p>.38). Age and reduced left ventricular ejection fraction (≤40%) were poor prognostic factor for 1 year mortality and MACE. Age was a significant univariate predictor for survival.

Conclusion: Early discharge, within 48 hours, carries significant high rate of major cardiovascular events but not statistically influent on 1 year mortality. Discharge within 72 hours carries lower rate of MACE with non-significant increase in mortality. The efficacy and safety of hospital discharge within 72 hours after ST elevation myocardial infarction seems reasonable and should be further explore in a large, randomized, prospective trials.