Kardiologiczne, niekardiologiczne powikłania i czynniki predykcyjne przedłużonej hospitalizacji u pacjentów bez cukrzycy z zawałem serca leczonych pierwotną przezskórną angioplastyką wieńcową

Abstract

Introduction. Prolonged patient stay after acute myocardial infarction (MI) results in higher costs. This study evaluated factors prolonging hospitalization after admission due to MI. Complications which also influence on longer hospital stay: both cardiac (CC) and non-cardiac (NCC), were analysed. Material and methods. The authors included prospectively 131 patients with MI undergoing primary percutaneous intervention. Following factors were collected: demographic and anthropomorphic data, types of infarction, 12-lead electrocardiography (ECG), echocardiography, standard blood tests including admission blood glucose level, fasting glycaemia, oral glucose tolerance test (OGTT) at discharge as well as renal filtration and lipid parameters. Length of hospital stay of Results. The mean age of patients was 62 ± 10.9 years, 71.8% were male. Factors which correlated significantly with longer hospitalisation were: older age (R = 0.47, p = 0.001), higher fasting glycaemia (R = 0.25, p = 0.027), reduced left ventricular ejection fraction (LVEF) (R = –0.36, p = 0.04), occurrence of ST-elevation MI (p = 0.0166), presence of CC (p = 0.0007) and NCC (p = 0.0001). Age, high blood glucose in OGTT and LVEF remained significant in a multivariate model predicting the duration of stay (R2 = 0.32). Factors predicting hospital stay ≥ 6 days in the multivariate model were: older age (p = 0.000), hip circumference (p = 0.014), anterior wall MI (p = 0.026) and usage of glycoprotein IIb/IIIa inhibitors (p = 0.022) with and area under the receiver operating characteristic curve (ROC): 0.792 [95% confidence interval (CI) 0.71–0.87] with specificity 71% and sensitivity 79%. Factors influencing CC occurrence in the multivariate model were: estimated glomerular filtration rate (p = 0.009), LVEF (p = 0.003) with ROC 0.735 (95% CI 0.65–0.82) with specificity 76% and sensitivity 60%. Factors influencing the occurrence of NCC were hyperlipidaemia (p = 0.021), and LVEF (p = 0.004) with an ROC: 0.792 (95% CI 0.71–0.87) with specificity 55% and sensitivity 90%. Conclusions. LVEF, age and blood glucose levels significantly prolonged hospital stay. The major factor associated with an increased risk of both CCs and NCCs was LVEF.