DRIVE-STEMI Supports Less Restrictive Driving Guidance After Acute MI

The ability to resume driving after a STEMI is important for many patients, for a variety of personal and economic reasons, but the advice they get from their physicians may be outdated, a new study suggests.

In the DRIVE-STEMI study, the risk of death was less than 5% in the first year after hospital discharge, with low risks of other events such as cardiac arrest, syncope, stroke, MI, and hospitalization for rhythm disturbances.

Various countries, including Canada, the United Kingdom, and Australia, have guidelines for medical professionals to follow when advising their patients about resuming driving. But lacking randomized trials of fitness to drive, the recommendations are somewhat arbitrary and based primarily on observational data of patients with a variety of medical conditions. Depending on where you look, suggested waiting times range from a few days to 4 weeks. Importantly, many of these recommendations use sudden cardiac death as a surrogate endpoint.

Video Topical Discussion

Quick Takes: Luiz Ybarra and Zachary Singer on the DRIVE-STEMI Study

February 26, 2025

The new study is the first to track a composite of clinical outcomes under the umbrella term “sudden cardiac incapacitation” as an indicator for driving fitness, noted senior author Luiz F. Ybarra, MD, PhD (Western University, London, Canada).

“Things other than sudden cardiac death may cause an event while you are driving that could lead to potential harm to the patient and the others,” Ybarra told TCTMD. “We used both a broad definition and also a stricter one that didn’t include MI or arrhythmia, but did include sustained tachycardia.”

Overall, Ybarra said the findings are a good framework for a fresh look at driving advice after STEMI, and should reassure both patients and their providers.

“We know that data drive recommendations and a lot of these recommendations have been made on assumptions,” he said. “By providing this evidence of outcomes, it’s going to be easier for societies from around the world to talk the same language and make decisions from there.”

DRIVE-STEMI was first presented as a poster at the American College of Cardiology (ACC) 2024 Scientific Session and was published January 21, 2025, as a research letter in Circulation.

Calculating Ideal Restriction Times

For the study, Ybarra and colleagues led by Zachary Singer, MD (Western University), used administrative health databases to create a cohort of 24,890 STEMI patients (mean age 63 years; 27% women) discharged between April 2017 and March 2021.

In the first year, 4.9% of patients died, 0.6% had cardiac arrest, 1.7% had syncope, 0.7% had stroke, 2.7% had MI, and 2.1% and 0.3%, respectively, had a hospitalization or emergency department visit for sustained arrhythmia or ventricular tachyarrhythmia. The majority of events occurred in the first 15 days after discharge.

At 1 year, the primary composite endpoint (death, cardiac arrest, syncope, stroke, MI, and hospitalization or emergency department visit for sustained arrhythmia) had occurred in 11% of the overall cohort and the secondary composite endpoint (death, cardiac arrest, syncope, stroke, or sustained ventricular tachyarrhythmia) in 7.4%.

By age group, the primary endpoint was seen in 6.7% of those age 65 or younger versus 16.8% of those over age 65. Similarly, the secondary endpoint was seen in 3.9% of those age 65 or younger and in 12.1% of those over age 65. The difference was driven by a higher rate of all cause death in the older versus younger group (9.1% vs 1.9%; P < 0.001 for all comparisons).

This has many effects on patients and their families, and we need good data if we are going to change regulations and help patients. Luiz F. Ybarra

According to the researchers, the data suggest that the ideal driving-restriction time for the entire cohort is 1 month based on the primary endpoint, but only 2 weeks based on the secondary endpoint. For the younger age group, it would be 2 weeks based on the primary endpoint, with no restriction based on the secondary endpoint.

Considering that the main difference between the age groups was all-cause death, which may have contributed to an overestimated of the risk of sudden cardiovascular incapacitation, the DRIVE-STEMI researchers say the ideal driving-restriction time for patients over age 65 years might be even lower than the endpoint predictions.

To TCTMD, Ybarra said countries with registries that capture granular CV data may want to look at these same endpoints and decide for themselves how to calculate reasonable driving restrictions.

“I think we also maybe need some papers looking at the economic and societal impact that this has on patients because . . . if a patient is the only driver in their home, what do they do? This has many effects on patients and their families, and we need good data if we are going to change regulations and help patients,” he added.