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Shorter hospital stay safe for older patients undergoing PCI for STEMI
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Patients aged at least 65 years discharged from the hospital as early as 48 hours after primary PCI for STEMI had similar outcomes compared with patients who stayed in the hospital for 4 to 5 days.
Researchers studied the safety of a shorter hospital stay in 33,920 patients with STEMI in the linked CathPCI Registry-CMS dataset. Eligible participants were aged at least 65 years and underwent primary PCI from 2004 to 2009.
Thirty-day outcomes were analyzed for three groups based on length of hospital stay: up to 3 days (26.9%); 4 to 5 days (46.3%); and at least 5 days (26.8%).
Longer length of stay was more common in older patients, women and those with comorbidities such as cardiogenic shock and multivessel disease. Higher ejection fraction and single-vessel disease were more common in patients with a shorter length of stay.
The researchers reported no significant difference in the rate of 30-day all-cause mortality between a length of stay of 4 to 5 days compared with up to 3 days (HR = 1; 95% CI, 0.74-1.34). Similarly, rates of MACE, defined as death, readmission for MI or unplanned revascularization, were not different for a length of stay of 4 to 5 days compared with up to 3 days (HR = 1.03; 95% CI, 0.86-1.25).
However, rates of adjusted mortality (HR = 2.3; 95% CI, 1.72-3.07) and MACE (HR = 1.75; 95% CI, 1.44-2.12) were significantly increased with a length of stay of at least 5 days compared with up to 3 days.
Independent predictors of longer length of stay included preoperative intra-aortic balloon pump, transfusion, vascular complication, cardiogenic shock, renal insufficiency, bleeding and hospital location in the southern United States.
The researchers also evaluated outcomes associated with very short length of stay of 1 to 2 days, with discharge on the day of or day after primary PCI. Very short length of stay was infrequent in this cohort (3.7%). A very short length of stay was associated with significantly worse outcomes at 30 days. Compared with very short length of stay, patients who stayed in the hospital for 3 to 4 days had a more than 50% reduction in adjusted mortality and a more than 40% reduction in MACE.
“Nearly one-half of the older patients with STEMI in the United States who are undergoing [primary] PCI have a 4- to 5-day [length of stay], yet patients discharged earlier have similar 30-day mortality and MACE,” the researchers concluded. “These data suggest that early discharge (but not within 48 [hours] after [primary] PCI) may be safe among selected older patients undergoing [primary] PCI for STEMI who do not develop in-hospital complications.” – by Rob Volansky
Disclosure: One researcher reports consulting and serving on the speakers’ bureau for Abbott Vascular, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly and Pfizer; another researcher is a proctor for transcatheter aortic valve replacement; and the other researchers report no relevant financial disclosures.
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