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直接经皮冠状动脉介入治疗后 ST 段抬高型心肌梗死患者的住院时间和短期预后：来自中国急性心肌梗死登记处的见解
Authors Lv J, Zhao Q, Yang J, Gao X, Zhang X, Ye Y, Dong Q, Fu R, Sun H, Yan X, Li W, Yang Y, Xu H
Received 20 July 2021
Accepted for publication 14 September 2021
Published 22 September 2021 Volume 2021:14 Pages 5981—5991
DOI https://doi.org/10.2147/IJGM.S330379
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Background: Length of stay (LOS) in patients with ST-segment elevation myocardial infarction (STEMI) is directly associated with financial pressure and medical efficiency. This study aimed to determine impact of LOS on short-term outcomes and associated factors of LOS in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI).
Methods: A total of 3615 patients with STEMI after PPCI in the China Acute Myocardial Infarction registry were included in the analysis. Predictors of prolonged LOS were analyzed by multivariate logistic regression model with generalized estimating equation. The impact of LOS on 30-day clinical outcomes was assessed.
Results: The median LOS was 9 (7, 12) days. Patients with a longer LOS (> 7 days) were older, more often in lower-level hospitals, had more periprocedural complications and hospitalization expense. Fourteen variables, such as weekend admission and lower-level hospitals, were identified as independent associated factors of prolonged LOS. There were no significant difference in 30-day major adverse cardiac and cerebrovascular events (MACCE), readmission, and functional status between patients with LOS≤ 7d and LOS> 7d after multivariate adjustment and propensity score matching. However, patients who discharged over one week had better medication adherence (adjusted odds ratio: 0.817, 95% confidence interval: 0.687– 0.971, P=0.022). Significant interaction was observed in medication use between gender and LOS (Pinteraction=0.038).
Conclusion: Patients with STEMI undergoing PPCI experienced a relatively long LOS in China, which resulted in more medical expenses but no improvement on 30-day MACCE, readmission, and functional recovery. Poor 30-day medication adherence with short LOS reflects unsatisfying transition of management from hospital to community. More efforts are needed to reduce LOS safely and improve the efficiency of medical care.
Keywords: length of stay, ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, prognosis