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

BackgroundProlonged 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. MethodsFrom July 2020 to July 2022, 5,093 consecutive STEMI patients treated with pPCI [&le;]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). ResultsSeven 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%. ConclusionsThe 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 KnownO_LIEarly 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. C_LIO_LICurrent 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. C_LIO_LIProlonged 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. C_LI What the Study AddsO_LIThe 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. C_LIO_LINearly 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. C_LIO_LIImplementation 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. C_LI