Background:
Length of hospital stay (LOS) following percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) significantly affects healthcare utilization and cost. There is paucity of data in the United States on the optimal LOS following PCI for STEMI. Our study objective is to assess the trend and predictors of prolonged LOS following PCI with stent placement for STEMI.
Methods:
Data were obtained from nationwide inpatient sample from 2003-2012, which is a 20% stratified probability sample of all non-federal acute care hospitalizations. Study outcome was prolonged LOS defined as stay in hospital for >4 days following PCI for STEMI. Cochrane-Armitage trend test and multivariable logistic regression models were used to delineate the predictors of prolonged LOS which included patient’s demographics, baseline comorbidities, presenting illnesses and in-hospital complications following PCI for STEMI.
Results:
A total of 223,267 patients with STEMI underwent PCI with stent placement with a mean LOS of 3.3±3.3 days. There were 16.1% patients who had prolonged LOS. The trend analysis showed that incidence of prolonged LOS decreased from 17.1% in year 2003 to 14.3% in year 2012 (p<0.05) (figure 1A). Pneumonia and peri-procedural intra-aortic balloon pump use were the strongest predictors for prolonged LOS. Other significant predictors for prolonged LOS following PCI for STEMI were history of congestive heart failure, anemia, respiratory failure requiring ventilator use; peri-procedural stroke and anemia or hemorrhage requiring blood transfusion (figure 1B).
Conclusions:
Incidence of prolonged LOS has consistently decreased over 10 years. Patient’s baseline comorbidities, illnesses at presentation and in-hospital complications can predict prolonged LOS following PCI for STEMI. Implementing an aggressive standard of care to prevent in-hospital complications can further shorten the LOS following PCI for STEMI.
TCT-448: Temporal Trends in the Use of Thrombectomy During Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in the United States
