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

Dávid Bauer,1 Vojtech Berka,1 Marek Neuberg,2 Denisa Odvodyová,1 Ivana Maliničová,1 Silvie Lašmanská,1 Simona Smitalová,1 Petr Mašek,2 Viktor Kočka,1 Zuzana Moťovská,1 Martin Kozel,1 Karolína Bartošková,1 Petr Toušek1 1Department of Cardiology, Third Faculty of Medicine Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic; 2SigmaCare Innovations Ltd, Prague, Czech RepublicCorrespondence: Dávid Bauer, Department of Cardiology, Third Faculty of Medicine Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic, Email [email protected] 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. Criteria include age under 80, Killip class I at admission, no resuscitation or ventilation, successful PCI, TIMI 3 flow post-PCI without significant residual lesion, no left main stem lesion and/or three vessel disease, no ventricular tachycardia over 24 hours after PCI, ejection fraction 50 percent or more, hemoglobin over 110g/l and self-sufficiency. 101 MI patients were selected, shown in a pie chart as NSTEMI and STEMI. Primary safety endpoint shows 100 percent survival at 30 days and 99 percent at 1.9 years. Secondary endpoints assess the impact of EDP on hospitalization time and costs before (Group A) and after (Group B) protocol implementation.Infographic on early discharge protocol for low-risk MI patients treated by PCI.Keywords: low risk, early discharge, myocardial infarction, percutaneous coronary intervention