Identifying STEMI Patients for Early Intensive Care Unit Discharge: The Codi-IAM Score

Abstract

ABSTRACT Background Prolonged intensive care unit (ICU) monitoring after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) may be unnecessary for truly low-risk patients, yet no bedside tool reliably classify these patients. We aimed to develop and externally validate a score that identifies STEMI patients at very low risk of 30-day death or ICU-level complications after pPCI and to examine its prognostic value through two years. Methods From July 2020 to July 2022, 5,093 consecutive STEMI patients treated with pPCI ≤24 hours from symptom onset were prospectively enrolled across 10 centers in Catalonia Region. Derivation (n = 3,649) and validation (n = 1,444) cohorts were pre-specified. Multivariable logistic regression isolated independent predictors of the composite endpoint (30-day all-cause death or in-hospital complications requiring ICU care). Each predictor was weighted by its odds ratio to generate the Codi-IAM Score (0–24 points). Results Seven variables entered the score: age > 75 years, Killip > I, malignant peri-procedural arrhythmia, left-main disease, three-vessel disease, non-radial access, and unsuccessful PCI (final TIMI < 3). Discrimination was excellent (AUC 0.87 derivation; 0.86 validation). Very low-risk patients (score 0; 44.3% of the population) experienced no deaths within 72 hours, a 1.7% in-hospital complication rate, and 0.2% 30-day mortality; two-year survival exceeded 98%. Conclusions The Codi-IAM Score, available immediately after pPCI, accurately flags nearly half of STEMI patients as having negligible early risk. Its adoption could safely shorten ICU monitoring and hospital stay, improving resource allocation without impact on clinical outcomes. What Is Known Early intensive care unit (ICU) discharge after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended by current guidelines but remains limited by safety concerns. Current European Society of Cardiology guidelines recommend at least 24 hours of continuous ICU monitoring for all STEMI patients, with only class IIb recommendation for early discharge within 72 hours. Prolonged ICU stays may be associated with increased nosocomial complications, delayed mobilization, higher costs, and inefficient use of critical care resources, particularly relevant during healthcare system strain. What the Study Adds The Codi-IAM Score is a simple, immediately available bedside tool incorporating seven variables that accurately identifies STEMI patients at very low risk of 30-day mortality or ICU-level complications after pPCI. Nearly half of STEMI patients (44.3%) score 0 on the Codi-IAM Score and experience negligible early risk: no deaths within 72 hours, 1.7% in-hospital complication rate, and 0.2% 30-day mortality. Implementation of the Codi-IAM Score in clinical practice could safely shorten ICU stays and hospital length of stay in approximately half of STEMI patients, improving resource allocation and patient satisfaction without compromising clinical outcomes over two-year follow-up.

Affiliated Institutions

• Hospital Universitari Germans Trias i Pujol ES
• Hospital Clínic de Barcelona ES
• Hospital Universitari Arnau de Vilanova ES
• Hospital Universitari de Girona Doctor Josep Trueta ES
• University Hospital Mútua de Terrassa ES
• Lung Institute US
• Consorci Institut D'Investigacions Biomediques August Pi I Sunyer ES
• Municipal Institute for Medical Research ES
• Hospital del Mar Research Institute ES
• Universitat Autònoma de Barcelona ES
• Hospital Universitari Joan XXIII de Tarragona ES
• Vall d'Hebron Hospital Universitari ES
• Centro de Investigación en Red en Enfermedades Cardiovasculares ES
• Bellvitge University Hospital ES
• Hospital de Sant Pau ES
• Hospital Del Mar ES
• Universitat de Barcelona ES
• Institut d'Investigació Biomédica de Bellvitge ES

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