Background: Primary percutaneous coronary intervention (PPCI) is now a standard treatment procedure for ST elevation myocardial infraction (STEMI) patients. Because of the many STEMI patients, there is a space constraint in coronary care unit, especially in Southeast Asian countries. Therefore, we practitioners should be evaluating if the patients could be safely discharged earlier. The current European Society of Cardiology STEMI 2017 guideline recommended early discharge in stable patients; however, the data are limited, especially in the Asian countries.

Objective: To determine the rate of 30-day, 1-year mortality, and readmission of STEMI patients that underwent PPCI and were discharged early within three days of admission, compared with the late discharge of more than three days after admission.

Materials and Methods: The present study was a retrospective cohort study at King Chulalongkorn Memorial Hospital. The authors collected consecutive cases of STEMI patients that underwent PPCI and were discharged between January 1999 and December 2015.The patients were divided into two groups as group 1 with early discharge within three days of admission and group 2 with late discharge more than three days of admission. The follow up on the mortality and readmission rates were collected at 30-day and 1-year after discharge.

Results: Out of 1,242 STEMI patients, 691 patients (55.6%) were classified in group 1 and 551 patients (44.4%) were in group 2. The 30-day mortality was 0.4% in group 1 compared with 1.3% in group 2 (HR 2.93, p=0.12) and 1-year mortality was 3.9% in group 1 compared with 8.0% in group 2 (HR 2.09, p=0.003). There was no difference in 30-day readmission between both groups at 1.3% versus 2.5% (OR 1.98, p=0.113), but there was a difference in 1-year readmission between the two groups at 4.5% versus 10.6% (OR 2.51, p<0.001). In multivariate analysis, the predictive factors for early discharged STEMI patients were male (adjusted OR 1.78, p=0.007), Killip classification 1, 2, and 3 (adjusted OR 5.85, p=0.001), EF greater than 40% (adjusted OR 2.51, p=0.001), and TIMI flow after PPCI 3 (adjusted OR 1.48, p=0.016).

Conclusion: Early discharge in STEMI patients within three days after PPCI is safe in terms of mortality and readmission compared to late discharge, especially in STEMI patients with Killip class I. Early discharge can provide more space for coronary care.

Keywords: STEMI; PPCI; Early discharge; Late discharge; Mortality; Readmission; Killip class

DOI: doi.org/10.35755/jmedassocthai.2021.08.12742

Received 6 May 2021 | Revised 16 July 2021 | Accepted 16 July 2021