Early Discharge After STEMI: Clinical Benefit and Cost-Effectiveness?

Improvements in reperfusion strategies for ST-segment elevation myocardial infarction (STEMI) have transformed the prognosis for this condition. Primary percutaneous coronary intervention (P-PCI) has enabled rapid clinical stabilization, with high technical success rates and a significant reduction in complications for many patients. This progress has led to a new risk profile in the post-event period, allowing an increasing number of patients to recover without adverse events during hospitalization.

However, the optimal length of hospital stay after P-PCI remains subject to debate. While clinical guidelines acknowledge the feasibility of early discharge in clinically stable patients, its implementation in everyday practice is still inconsistent. Factors such as perceived safety, healthcare system structure, and, especially, the rising costs of hospital care continue to fuel this controversy.

Rathod et al. conducted a study aimed at assessing the long-term safety of early hospital discharge (<48 hours, EHD) by analyzing major adverse cardiovascular events (MACE) at 12 months. They also assessed treatment titration and adherence over the same period, as well as the cost-effectiveness of this strategy in low-risk STEMI patients following successful P-PCI.

Researchers analyzed the case of 1500 patients who were discharged early between April 2020 and March 2023. Mean patient age was 59.4 years; 84.1% of subjects were men, and 24.5% had diabetes. There was a high rate of ventriculography, reflecting early assessment of ventricular function, although difficulties were reported in obtaining immediate echocardiograms.

The average length of stay for the EHD group was 24.9 hours (range: 17 to 40 hours), compared to 68.1 hours in the standard discharge group (P <0.001). At the 12-week follow-up, 69% of EHD patients were on optimal doses of medical therapy. Regarding medication adherence, 80% reported moderate to high adherence (Morisky Scale = 8).

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The early discharge group had an overall mortality rate of 0.6% (0.13% cardiovascular death), with a MACE rate of 3.1%. In contrast, the cohort with ≥48 hours of hospitalization had a MACE rate of 5.5%. In the propensity score-matched analysis, there were no significant differences in adjusted mortality (hazard ratio [HR]: 0.94; 95% confidence interval [CI]: 0.78–1.22), but there was a significant reduction in MACE (HR: 0.70; 95% CI: 0.58–0.92).

A 30-day decision tree model was used, incorporating direct costs (hospitalization, readmissions, consultations) and clinical outcomes (major adverse events, readmissions, quality of life). The results showed that the early discharge strategy not only reduced total costs but also offered at least equivalent clinical benefit, which warranted its classification as a “dominant” strategy. This term, in health economics, refers to an intervention that is both more effective and less costly than its comparator.

Conclusions

This analysis supports early discharge after P-PCI in carefully selected low-risk STEMI patients. The strategy proves to be not only clinically safe but also economically efficient.

Original Title: Cost-Effectiveness of Early Discharge (<48 Hours) for Low-Risk Patients Following PPCI for STEMI.

Reference: Rathod KS, Comer K, Casey-Gillman O, Moore L, Antoniou S, Fhadil S, Wright P, Mather J, Yick MCT, Vyas R, Wang RB, Ozkor MA, Guttmann OP, Baumbach A, Archbold RA, Wragg A, Jain AK, Choudry FA, Mathur A, Jones DA. Cost-Effectiveness of Early Discharge (<48 Hours) for Low-Risk Patients Following PPCI for STEMI. JACC Cardiovasc Interv. 2025 Jun 23;18(12):1499-1509. doi: 10.1016/j.jcin.2025.04.045. PMID: 40562463.