Feasibility and Safety of an Early Discharge Strategy after Low-Risk Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: The EDAMI Pilot Trial

Abstract

Objectives: This pilot trial evaluated the feasibility and safety of an early discharge strategy (EDS: ≤72 h, followed by outpatient lifestyle interventions), in comparison with a conventional discharge strategy (CDS) for low-risk (Zwolle risk score ≤3) ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty. Methods: One hundred patients were randomized to an EDS (n = 54) or a CDS (n = 46). The primary end point was the feasibility of the EDS: (1) ≥70% of EDS patients discharged ≤72 h, (2) ≥70% visited by a nurse ≤7 days after discharge, (3) ≥70% with ≥3 visits by the nurse and (4) ≥70% visited by a cardiologist ≤3 months. Results: The mean age was 59.2 ± 12.2 years and ejection fraction 54.0 ± 7.1%. Eighty-six percent were male (12% diabetics). Vascular access was radial in 91%. Ischemic time was ≤4 h in 75%. Length of stay was shorter in EDS as compared with CDS (70.1 ± 8.1 vs. 111.8 ± 28.3 h, p < 0.001). EDS feasibility was: (1) 72.2%; (2) 81.5%; (3) 76.9%; (4) 72.2%. There were no adverse events or differences in intervention goals and quality of life between groups. Conclusions: An EDS in low-risk STEMI patients is feasible and seems to be safe. A shorter hospital stay could benefit patients and health care systems.