Temporal Trends and Factors Associated With Prolonged Length of Stay in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

Improved procedural techniques and process of care initiatives have decreased length of stay (LOS) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, there remains a subset of patients who continue to require longer LOS. We used the 2005 to 2014 National Inpatient Sample databases to identify all hospitalizations for PPCI for STEMI in patients ≥18 years of age. Hospitalizations in which patients were discharged home alive were included. Multivariable linear and logistic regression models were used to examine temporal trends in LOS and to identify independent predictors of longer LOS (LOS >3 days). In 678,545 hospitalizations for PPCI for STEMI, mean ± standard error of mean LOS decreased significantly from 3.3 (±0.04) days to 2.7 (±0.02) days (ptrend<0.001). There was a marked decrease in the proportion of STEMI hospitalizations with LOS >3 days from 31.9% in 2005 to 16.9% in 2014 (p<0.001). Patient demographics, co-morbidities, hospital region, use of mechanical circulatory support, and periprocedural complications were independently associated with longer LOS. In conclusion, LOS for hospitalizations for PPCI for STEMI has decreased significantly over time. Targeting strategies to reduce procedure-related risk may translate into shorter LOS.