Universal Early Discharge Protocol for Acute Myocardial Infarction: A Single-Center Prospective Validation

Background and Aims: Selected low-risk myocardial infarction (MI) patients may be safely discharged within 72 hours. The aim was to prospectively validate a previously created protocol for selecting low-risk MI patients and to assess their safety. Methods: We have previously proposed an early discharge protocol (EDP) for selecting low-risk acute coronary syndrome patients. We implemented EDP in July 2021 and selected patients were discharged within 72 hours. Survival was verified by the National Office of Health and Statistical Information. Finally, we compared all low-risk MI patients prior to (October 2018 to July 2021, Group A) and after (July 2021 to October 2023, Group B) EDP implementation in terms of length of hospital stay and financial costs. Results: From July 2021 to September 2024, we selected 101 low-risk MI patients treated by percutaneous coronary intervention. There were 41.6% STEMI (n = 42). We report 100% survival at 30 days. Only a single death occurred in an average follow-up of 1.9 years (± 0.9). Discharge within 3 days was more often after EDP implementation, with the mean hospital stay of 4.7 days (95% CI = 4.4 to 4.9) and 4.2 days (95% CI = 4.0 to 4.4) in Group A and Group B, respectively, p = 0.053. Department-associated healthcare costs decreased from 2,105.4 euros (95% CI = 1,922.6 to 2,288.3) in Group A to 1,557.9 euros (95% CI = 1,428.5 to 1,946.1) in Group B, p = 0.016. Conclusion: Implementation of a simple, universal protocol for selecting low-risk MI patients is feasible, represents excellent mid-term safety, and is associated with a decrease in healthcare-associated costs during index hospitalization.