Document Type : Original Article(s)
Authors
- Fardin Mirbolouk 1
- Arsalan Salari 1
- Mahboobeh Gholipour 2
- Salman Nikfarjam 2
- Reza Pourbahador 2
- Hamideh Mohamadnia 3
- Niloufar Akbari-Parsa 2
1 Associate Professor, Cardiovascular Diseases Research Center AND Heshmat Hospital, Department of Cardiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
2 Assistant Professor, Cardiovascular Diseases Research Center AND Heshmat Hospital, Department of Cardiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
3 Cardiovascular Diseases Research Center AND Heshmat Hospital, Department of Cardiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Abstract
BACKGROUND: Decreasing the hospital length of stay (LOS) in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is an issue which is related to reducing hospital costs. This study was aimed to determine the average number of hospital LOS among patients with STEMI treated by PPCI and predictors of longer LOS.METHODS: This cross-sectional study was performed on 561 patients with STEMI who referred to Heshmat Hospital, Rasht, north of Iran, within 2015-2018. As soon as STEMI was detected, patients were transferred to the catheterization laboratory (cath lab) in the shortest possible time and underwent PPCI. A questionnaire including characteristics of patients, procedures, and in-hospital adverse events was completed. Data were analyzed with SPSS software.RESULTS: The mean age of patients was 59.36 ± 11.90 years. 74.2% (n = 416) of subjects were men and 25.8% (n = 145) were women. The hospital LOS of 3 to 6 days had the highest prevalence up to 47%. The results of the multiple logistic regression showed that risk of hospital LOS > 6 days in unsuccessful percutaneous coronary intervention (PCI) was 33.2 versus 66.8 in successful PCI (P = 0.001). Moreover, the risk of hospital LOS > 6 days in subjects who had post-procedure complication, problems at admission, and primary comorbidities was 9.13 (7.22-11.53)-fold, 4.09 (2.86-5.85)-fold, and 1.75 (1.35-2.27)-fold more than those who had not, respectivelyCONCLUSION: By identifying controllable predictive factors associated with prolonged hospitalization after PPCI, the length of hospitalization can be decreased; also, the patient remission can be enhanced and hospital costs reduced.
Keywords
- Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle-income countries. Curr Probl Cardiol 2010; 35(2): 72-115.
- Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. Int J Cardiol 2013; 168(2): 934-45.
- Forouzanfar MH, Sepanlou SG, Shahraz S, Dicker D, Naghavi P, Pourmalek F, et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Arch Iran Med 2014; 17(5): 304-20.
- Schlatter RP, Hirakata VN, Polanczyk CA. Estimating the direct costs of ischemic heart disease: evidence from a teaching hospital in BRAZIL, a retrospective cohort study. BMC Cardiovasc Disord 2017; 17(1): 180.
- Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: The Isfahan Cohort Study. Arch Iran Med 2013; 16(3): 138-44.
- Smith EJ, Mathur A, Rothman MT. Recent advances in primary percutaneous intervention for acute myocardial infarction. Heart 2005; 91(12): 1533-6.
- Koyanagi R, Hagiwara N, Kasanuki H, Tsurumi Y, Ogawa H. Primary percutaneous coronary intervention vs conservative treatment for acute ST elevation myocardial infarction: Short-and long-term follow-up according to disease severity. Circ J 2008; 72(9): 1391-6.
- Charytan DM, Desai M, Mathur M, Stern NM, Brooks MM, Krzych LJ, et al. Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease. Kidney Int 2016; 90(2): 411-21.
- Iwasaki K. Myocardial ischemia is a key factor in the management of stable coronary artery disease. World J Cardiol 2014; 6(4): 130-9.
- Noman A, Zaman AG, Schechter C, Balasubramaniam K, Das R. Early discharge after primary percutaneous coronary intervention for
- ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2013; 2(3): 262-9.
- Schellings DA, Ottervanger JP, van 't Hof AW, de Boer MJ, Dambrink JH, Hoorntje JC, et al. Predictors and importance of prolonged hospital stay after primary PCI for ST elevation myocardial infarction. Coron Artery Dis 2011; 22(7): 458-62.
- Resnic FS, Shah SP. Balloon-to-door time: Emerging evidence for shortening hospital stay after primary PCI for STEMI. J Am Coll Cardiol 2015; 65(12): 1172-4.
- Antoni ML, Boden H, Delgado V, Boersma E, Fox K, Schalij MJ, et al. Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J 2012; 33(1): 96-102.
- Grines CL, Marsalese DL, Brodie B, Griffin J, Donohue B, Costantini CR, et al. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction. J Am Coll Cardiol 1998; 31(5): 967-72.
- Kotowycz MA, Syal RP, Afzal R, Natarajan MK. Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention? Can J Cardiol 2009; 25(10): 585-8.
- Isik T, Ayhan E, Uluganyan M, Gunaydin ZY, Uyarel H. Predictors of prolonged in-hospital stay after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Angiology 2016; 67(8): 756-61.
- Zeymer U, Arntz HR, Dirks B, Ellinger K, Genzwurker H, Nibbe L, et al. Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the German Prehospital Myocardial Infarction Registry (PREMIR). Resuscitation 2009; 80(4): 402-6.
- Ahmadi A, Sajjadi H, Etemad K, Khaledifar A, Mobasherii M. Epidemiological Characteristics and Determinants of Mortality in Acute Coronary Syndrome in Iran. J Mazandaran Univ Med Sci 2015; 25(124): 1-9. [In Persian].
- Karabulut A, Cakmak M, Uzunlar B, Bilici A. What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention? Cardiol J 2011; 18(4): 378-84.
- Swaminathan RV, Rao SV, McCoy LA, Kim LK, Minutello RM, Wong SC, et al. Hospital length of stay and clinical outcomes in older STEMI patients after primary PCI: A report from the National
- Cardiovascular Data Registry. J Am Coll Cardiol 2015; 65(12): 1161-71.
- Melberg T, Jorgensen M, Orn S, Solli T, Edland U, Dickstein K. Safety and health status following early discharge in patients with acute myocardial infarction treated with primary PCI: A randomized trial. Eur J Prev Cardiol 2015; 22(11): 1427-34.