Very Early Discharge After Primary Percutaneous Coronary Intervention (PCI) in Low-Risk ST-Segment Elevation Myocardial Infarction (STEMI) Patients: Safety and Feasibility From a Prospective Randomized Study

Background: Contemporary management of ST-segment elevation myocardial infarction (STEMI) has markedly evolved with the widespread adoption of primary percutaneous coronary intervention (PCI), radial-access strategies, and optimized antithrombotic therapy. In clinically stable patients, serious post-procedural complications have become increasingly uncommon beyond the first 24 hours, raising questions regarding the necessity of prolonged hospitalization after uncomplicated STEMI. The issue becomes even more relevant in resource-limited healthcare systems, where coronary care unit capacity often remains critically constrained. Although observational studies have suggested that selected low-risk patients may safely undergo very early discharge, prospective randomized data remain limited, particularly in low- and middle-income countries. Objective: To assess the safety and feasibility of very early discharge (≤48 hours) after successful primary percutaneous coronary intervention (PCI) in selected low-risk STEMI patients. Methods: We conducted a prospective, randomized, open-label, single-center study between June 2024 and June 2025 at Mohammed VI University Hospital Center, Marrakech, Morocco. During the study period, 544 consecutive patients were admitted for STEMI. Among them, 179 fulfilled predefined low-risk criteria, including preserved left ventricular ejection fraction (>50%), successful radial-access PCI with final thrombolysis in myocardial infarction (TIMI) 3 flow, Killip class I presentation, limited coronary artery disease burden, and absence of major in-hospital complications during the first 24 hours. Eligible patients were randomized in a 1:1 ratio to either very early discharge (≤48 hours) or routine discharge (>48 hours). The primary endpoint was major adverse cardiovascular events (MACE) at 3 months, defined as all-cause mortality, recurrent myocardial infarction, hospitalization for heart failure, or definite/probable stent thrombosis. Results: A total of 82 patients were assigned to the very early discharge group and 97 to routine discharge. Median hospital stay in the early discharge group was 25.8 hours. Baseline clinical and angiographic characteristics were comparable between groups, with preserved left ventricular systolic function and successful radial-access PCI achieved in all randomized patients. At the three-month follow-up, MACE occurred in 2 patients (2.4%) in the early discharge group and in 2 patients (2.1%) in the routine discharge group, with no significant difference between discharge strategies (p = 1.00). In the early discharge group, one patient (1.2%) died, and one patient (1.2%) required hospitalization for heart failure. In the routine discharge group, one patient (1.0%) experienced recurrent myocardial infarction and one patient (1.0%) required hospitalization for heart failure. No cases of stent thrombosis occurred during follow-up. Conclusion: In this prospective randomized study involving selected low-risk STEMI patients, very early discharge (≤48 hours) after successful primary PCI was not associated with an apparent increase in adverse cardiovascular events during the three-month follow-up. Although the modest sample size and short follow-up preclude definitive conclusions regarding long-term safety, these findings support the feasibility of an individualized very early discharge strategy in carefully selected patients, particularly in resource-constrained healthcare settings.