Off-Site Percutaneous Coronary Intervention Reduces Hospital Length of Stay in Vulnerable Patients With Acute Myocardial Infarction

Abstract

Primary percutaneious coronary intervention (PCI) is rapidly becoming the preferred therapy for acute ST-segment elevation myocardial infarction (AMI) because of a lower mortality rate and decreased hospital length of stay (LOS) compared with thrombolysis. However, generalizability of these findings beyond randomized trials involving specialized centers has not been well described. Many urban county hospitals care for disadvantaged patients and lack on-site PCI capabilities. Moreover, treatment delays and worse clinical outcomes have been demonstrated in this population. We sought to determine whether a shift from uniform on-site thrombolysis to off-site PCI for disadvantaged AMI patients reduces hospital LOS. We retrospectively reviewed 91 AMI patients presenting to an inner-city hospital without PCI capabilities, comparing 47 consecutive patients treated with off-site PCI with 44 historical controls who received thrombolysis. The primary end point was hospital LOS. Multivariable regression was used to adjust for baseline differences between the groups. Unadjusted median LOS was lower in the PCI group than the thrombolytic group (4 versus 6 days, P = 0.004). These differences remained after adjusting for variation in baseline sociodemographic and clinical characteristics including the presence of cardiogenic shock. Fifteen patients (34%) in the thrombolytic group required urgent catheterization during index hospitalization versus none in the PCI group (P < 0.001). No differences in death or nonfatal reinfarction were noted 6 months after index event. This study supports the usefulness of primary PCI beyond highly selected populations in randomized controlled trials. Specifically, PCI significantly decreases hospital LOS among vulnerable AMI patients.