Lv Junxing, Zhao Qinghao, Yang Jingang, Gao Xiaojin, Zhang Xuan, Ye Yunqing, Dong Qiuting, Fu Rui, Sun Hui, Yan Xinxin, Li Wei, Yang Yuejin, Xu Haiyan
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Int J Gen Med. 2021 Sep 22;14:5981-5991. doi: 10.2147/IJGM.S330379. eCollection 2021.
Length of stay (LOS) in patients with ST-segment elevation myocardial infarction (STEMI) is directly associated with financial pressure and medical efficiency. This study aimed to determine impact of LOS on short-term outcomes and associated factors of LOS in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI).
A total of 3615 patients with STEMI after PPCI in the China Acute Myocardial Infarction registry were included in the analysis. Predictors of prolonged LOS were analyzed by multivariate logistic regression model with generalized estimating equation. The impact of LOS on 30-day clinical outcomes was assessed.
The median LOS was 9 (7, 12) days. Patients with a longer LOS (>7 days) were older, more often in lower-level hospitals, had more periprocedural complications and hospitalization expense. Fourteen variables, such as weekend admission and lower-level hospitals, were identified as independent associated factors of prolonged LOS. There were no significant difference in 30-day major adverse cardiac and cerebrovascular events (MACCE), readmission, and functional status between patients with LOS≤7d and LOS>7d after multivariate adjustment and propensity score matching. However, patients who discharged over one week had better medication adherence (adjusted odds ratio: 0.817, 95% confidence interval: 0.687-0.971, P=0.022). Significant interaction was observed in medication use between gender and LOS (P=0.038).
Patients with STEMI undergoing PPCI experienced a relatively long LOS in China, which resulted in more medical expenses but no improvement on 30-day MACCE, readmission, and functional recovery. Poor 30-day medication adherence with short LOS reflects unsatisfying transition of management from hospital to community. More efforts are needed to reduce LOS safely and improve the efficiency of medical care.
ST段抬高型心肌梗死（STEMI）患者的住院时间（LOS）与经济压力和医疗效率直接相关。本研究旨在确定住院时间对接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者短期预后的影响以及住院时间的相关因素。
中国急性心肌梗死注册研究中共有3615例接受PPCI治疗后的STEMI患者纳入分析。采用广义估计方程的多因素logistic回归模型分析住院时间延长的预测因素。评估住院时间对30天临床结局的影响。
住院时间中位数为9（7，12）天。住院时间较长（>7天）的患者年龄较大，更多在基层医院就诊，围手术期并发症和住院费用更多。14个变量，如周末入院和基层医院等，被确定为住院时间延长的独立相关因素。多因素调整和倾向评分匹配后，住院时间≤7天和>7天的患者在30天主要不良心脑血管事件（MACCE）、再入院和功能状态方面无显著差异。然而，出院超过一周的患者药物依从性更好（调整后的比值比：0.817，95%置信区间：0.687-0.971，P=0.022）。在药物使用方面，性别与住院时间之间存在显著交互作用（P=0.038）。
在中国，接受PPCI治疗的STEMI患者住院时间相对较长，这导致了更多的医疗费用，但在30天MACCE、再入院和功能恢复方面并无改善。住院时间短导致30天药物依从性差，反映出从医院到社区的管理过渡不尽人意。需要做出更多努力以安全地缩短住院时间并提高医疗效率。
