The Safety and Outcomes of Very Early Discharge (<48 Hours) in STEMI Patients: A Focus on Anterior vs. Non-Anterior Infarct

Introduction: The advancements in ST-elevations myocardial infarctions (STEMI) management have significantly improved clinical outcomes and reduced the length of hospital stay (LoS). However, the safety of very early discharge (<48 hours) among high-risk groups, remains uncertain. This study aims to evaluate the safety and feasibility of very early discharge (<48 hours) following primary percutaneous coronary intervention (pPCI) in STEMI patients, comparing clinical outcomes, major adverse cardiovascular events (MACE) and unplanned 30-day readmission rates, between anterior versus non-anterior STEMI patients.

Materials and methods: This retrospective, single-center study included 363 STEMI patients discharged within 48 hours post-pPCI between 2020 to 2023. Patients were divided into left anterior descending (LAD) (n=163) and non-LAD (n=200) groups. Baseline characteristics, procedural details, and clinical outcomes were analyzed.

Results and discussion: No significant differences were observed between the LAD and non-LAD groups in age (58.72 ± 12.11 vs. 60.35 ± 11.31 years, P=0.188) or gender distribution (males: 84.7% vs. 78.0%, P=0.108). The LAD group had shorter ischemia times (207.4 ± 207 vs. 260.1 ± 279 minutes, P=0.04), higher CPK max (1726.2 ± 1578.6 vs. 1320.8 ± 1261.4, P=0.004) and troponin max (4050.8 ± 3458.9 vs. 3260.0 ± 2765.8, P=0.019). Decreased left venticular ejection fraction (LVEF) was more frequent in the LAD group (28.4% vs. 9.5%, P<0.001), while acute renal failure occurred only in the non-LAD group (2.5%, P=0.042). Other outcomes, including 30-day readmissions (7.4% vs. 8.5%, P=0.691), arrhythmias, and stent-related complications, showed no significant differences between the groups.

Conclusions: Very early discharge (<48 hours) following pPCI appears to be safe among STEMI patients, including those with anterior STEMI. Despite the higher incidence of decreased LVEF in the LAD group, there was no significant difference in outcomes between both groups. These findings support the consideration of very early discharge strategy in high risk patients.