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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 April 1, 2025 e823 regarding the optimal length of stay after MI. Patients with STEMI represent a higher risk cohort who may require longer length of stay. Available data suggest that an early discharge strategy of <3 days from admission is not associated with increased mortality for low-risk patients after STEMI who have undergone PCI.3–8 The Zwolle score has been recommended as a clinical tool to help identify patients after PPCI in STEMI at low risk of death (low-risk patients, score ≤3) who can potentially be discharged earlier from the hospital (48 to 72 hours). Predictors of mortality in the Zwolle score include age, Killip class, postprocedural TIMI Flow Grade, 3-vessel disease, anterior infarction, and ischemic time.3 Optimal length of stay in the setting of NSTE-ACS has been less rigorously studied. Small retrospective studies have suggested safety of very early or same-day discharge after PCI for patients with ACS, with most (71%) of same-day discharge being troponin-negative.9 Patients being considered for early discharge should be clinically stable without evidence of ongoing ischemia, acute kidney injury, LV dysfunction, HF, and procedural complications and with adequate postdischarge support.8 Hospitals and care providers should ensure that patients have access to postdischarge prescription medications and adequate follow-up. Recommendation-Specific Supportive Text 1 The number of studies addressing telemetry dura- tion are few and the focus has been on arrhythmia monitoring, not continuous ST-segment monitoring. Continuous ST-segment monitoring can be considered for higher-risk patients, including those with suspected ischemia who are not yet revascularized.1,10–14 Patients with ACS who are at low risk for cardiac arrhythmias require rhythm monitoring for ≤24 hours or until coronary revascularization (whichever comes first) in a telemetry unit, while individuals at intermediate to high risk for cardiac arrhythmia may require rhythm monitoring for >24 hours in a telemetry unit or in an intermediate care unit, depending on the clinical presentation, degree of revascularization, and early postrevascularization course with input from the treating cardiologist.10,12–14 10.4 Noninvasive Diagnostic Testing Prior to Hospital Discharge Recommendation for Noninvasive Diagnostic Testing Prior to Hospital Discharge COR LOE Recommendation 1 C-LD 1 In patients with ACS, an assessment of LVEF is recommended prior to hospital discharge to guide therapy and for risk stratification.1–3 Synopsis In patients with ACS, LV function should be routinely evaluated in patients prior to hospital discharge to help guide therapy and for risk stratification.1–3 Transthoracic echocardiography is generally the preferred modality because it is noninvasive and can provide a comprehensive assessment of ventricular and valvular function, as well as possibly detect LV thrombus or mechanical complications. Transthoracic echocardiography is therefore strongly preferred for all patients hospitalized with STEMI because complications may be more likely to be present. In patients where transthoracic echocardiography is nondiagnostic, cardiac magnetic resonance imaging is a reasonable alternative in clinically stable patients. Alternatively, LV function and some mechanical complications can be assessed invasively with left ventriculography in the cardiac catheterization laboratory, but other data regarding valvular function and wall motion are best evaluated with noninvasive methods like transthoracic echocardiography or cardiac magnetic resonance imaging. LV function may also be estimated noninvasively by myocardial perfusion imaging testing, but this will also provide incomplete information regarding the presence or absence of other complications of MI. For patients in whom LV function is found to be reduced, a repeat echocardiogram should be performed in 6 to 12 weeks to further guide treatment decisions and for consideration of need for an ICD.4,5 Recommendation-Specific Supportive Text 1 LV function should be routinely evaluated in patients with ACS prior to hospital discharge because LVEF guides therapeutic interventions and facilitates risk stratification. The diagnosis of LV dysfunction is important because it may trigger consideration for the initiation or optimization of guideline-directed therapeutic interventions for patients with HF or depressed LV function. It also helps identify patients with reduced LVEF who may require consideration for future primary prevention implantation of an ICD. Besides LVEF, transthoracic echocardiography facilitates the assessment of regional wall motion abnormalities, valvular function, mechanical complications,4 and LV thrombus.5 In cases in which LV function cannot be adequately assessed despite the use of contrast echocardiography, cardiac magnetic resonance is the preferred imaging modality for clinically stable patients.6–9 10.5 Discharge Planning 10.5.1 Patient Education Synopsis Patient education is universally valued and aims to deliver information from clinicians to patients to improve Downloaded from http://ahajournals.org by on October 7, 2026