Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice
Abstract
1. Introduction
2. Experimental Section
2.1. Study Population
2.2. Statistical Analysis
3. Results
3.1. Patients’ Characteristics
3.2. Clinical Outcome
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Patients Surviving until Hospital Discharge (n = 190) | All Patients (n = 212) | |||||
---|---|---|---|---|---|---|
LOS 8 <8 Days (92 Patients) | LOS ≥8 Days (98 Patients) | p-Value | Higher-Risk (158 Patients) | Low-Risk (54 Patients) | p-Value | |
Baseline presentation | ||||||
ST-elevation MI 1 (%) | 22 | 37 | 0.03 | 33 | 24 | 0.24 |
Age (years) | 64 ± 11 | 69 ± 12 | 0.003 | 71±11 | 57 ± 8 | <0.001 |
Male gender (%) | 71 | 64 | 0.36 | 63 | 76 | 0.097 |
Hypertension history (%) | 82 | 82 | 1.0 | 79 | 78 | 0.85 |
Diabetes history (%) | 29 | 41 | 0.13 | 41 | 24 | 0.03 |
COPD history 2 (%) | 9 | 14 | 0.26 | 13 | 7 | 0.45 |
Smoking (%) | 48 | 45 | 0.77 | 38 | 65 | 0.001 |
Stroke history (%) | 8 | 11 | 0.46 | 11 | 2 | 0.048 |
MI history (%) | 29 | 23 | 0.41 | 27 | 22 | 0.59 |
In-hospital characteristics | ||||||
LVEF 3 (%) | 55 (Q1: 45; Q3: 60) | 45 (Q1: 38; Q3: 55) | <0.001 | 45 (Q1: 37 Q3: 52) | 56 (Q1: 50 Q3: 60) | <0.001 |
LAD 4 culprit (%) | 29 | 40 | 0.17 | 39 | 30 | 0.25 |
Multi-vessel disease (%) | 23 | 48 | <0.001 | 48 | 0 | <0.001 |
Staged revascularization (%) | 14 | 33 | 0.003 | 28 | 4 | <0.001 |
Ventricular arrhythmia (%) | 9 | 16 | 0.13 | 11 | 0 | 0.008 |
GFR 5 (mL/min/1.73 m2) | 85 ± 28 | 77 ± 34 | 0.08 | 72 ± 33 | 92 ± 23 | <0.001 |
RBC 6 transfusion (%) | 2 | 4 | 0.68 | 4 | 2 | 0.68 |
Respiratory infections (%) | 6 | 20 | 0.006 | 19 | 6 | 0.017 |
ACEI/ARB 7 (%) | 88 | 88 | 1.0 | 78 | 91 | 0.04 |
B-blocker (%) | 88 | 90 | 0.82 | 80 | 89 | 0.21 |
Loop diuretics (%) | 24 | 42 | 0.009 | 47 | 9 | <0.001 |
Aldosterone antagonists (%) | 13 | 33 | 0.002 | 28 | 6 | <0.001 |
ST-Elevation MI 1 (65 Patients) | Non-ST-Elevation MI (147 Patients) | p-Value | |
---|---|---|---|
Baseline presentation | |||
Age (years) | 67 ± 13 | 67 ± 11 | 0.93 |
Male gender (%) | 60 | 69 | 0.21 |
Hypertension history (%) | 71 | 82 | 0.07 |
Diabetes history (%) | 35 | 37 | 0.88 |
COPD history 2 (%) | 11 | 12 | 1.0 |
Smoking (%) | 48 | 43 | 0.65 |
Stroke history (%) | 6 | 9 | 0.59 |
MI history (%) | 12 | 31 | 0.003 |
Low-risk (%) | 20 | 28 | 0.24 |
In-hospital characteristics | |||
Length of hospital stay (d) | 8 (Q1: 7; Q3: 9) | 7 (Q1: 6; Q3: 10) | 0.19 |
LVEF 3 (%) | 45 (Q1: 38; Q3: 55) | 50 (Q1: 40; Q3: 55) | 0.14 |
LAD 4 culprit (%) | 45 | 33 | 0.12 |
Multi-vessel disease (%) | 31 | 38 | 0.35 |
Staged revascularization (%) | 20 | 22 | 0.86 |
Ventricular arrhythmia (%) | 11 | 7 | 0.41 |
GFR 5 (mL/min/1.73 m2) | 87 ± 35 | 73 ± 30 | 0.006 |
RBC 6 transfusion (%) | 5 | 3 | 0.7 |
Respiratory infections (%) | 15 | 16 | 1.0 |
ACEI/ARB 7 (%) | 78 | 83 | 0.44 |
B-blocker (%) | 80 | 84 | 0.56 |
Loop diuretics (%) | 36 | 38 | 0.76 |
Aldosterone antagonists (%) | 31 | 18 | 0.04 |
Multi-Vessel Disease (76 Patients) | No Multi-Vessel Disease (136 Patients) | p-Value | |
---|---|---|---|
Baseline presentation | |||
ST-elevation MI 1 (%) | 26 | 33 | 0.35 |
Age (years) | 67 ± 10 | 67 ± 12 | 0.72 |
Male gender (%) | 71 | 64 | 0.36 |
Hypertension history (%) | 72 | 82 | 0.11 |
Diabetes history (%) | 41 | 34 | 0.37 |
COPD history 2 (%) | 8 | 13 | 0.27 |
Smoking (%) | 46 | 44 | 0.89 |
Stroke history (%) | 7 | 10 | 0.61 |
MI history (%) | 24 | 26 | 0.74 |
Low-risk (%) | 0 | 40 | <0.001 |
In-hospital characteristics | |||
Length of hospital stay (d) | 8 (Q1: 7; Q3: 10) | 7 (Q1: 5; Q3: 9) | <0.001 |
LVEF 3 (%) | 45 (Q1: 39; Q3: 55) | 50 (Q1: 40; Q3: 58) | 0.14 |
LAD 4 culprit (%) | 34 | 38 | 0.66 |
Staged revascularization (%) | 54 | 4 | <0.001 |
Ventricular arrhythmia (%) | 9 | 7 | 0.61 |
GFR 5 (mL/min/1.73 m2) | 81 ± 35 | 76 ± 30 | 0.31 |
RBC 6 transfusion (%) | 3 | 4 | 0.71 |
Respiratory infections (%) | 16 | 15 | 1.0 |
ACEI/ARB 7 (%) | 77 | 84 | 0.27 |
B-blocker (%) | 83 | 82 | 1.0 |
Loop diuretics (%) | 33 | 40 | 0.37 |
Aldosterone antagonists (%) | 17 | 24 | 0.29 |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
OR 7 | 95% CI 8 | p-Value | OR | 95% CI | p-Value | |
Baseline characteristics | ||||||
Age (per one year increase) | 1.04 | 1.01–1.07 | 0.004 | 1.04 | 1.01–1.07 | 0.016 |
Female gender | 1.3 | 0.7–2.4 | 0.35 | |||
Arterial hypertension | 1.0 | 0.48–2.1 | 0.98 | |||
Diabetes mellitus | 1.7 | 0.91–3.0 | 0.1 | |||
History of MI 1 | 0.74 | 0.4–1.4 | 0.36 | |||
History of CABG 2 | 0.69 | 0.15–3.2 | 0.64 | |||
History of stroke | 1.5 | 0.57–4.1 | 0.4 | |||
Smoking | 0.89 | 0.5–1.6 | 0.69 | |||
Hyperlipidemia | 0.87 | 0.47–1.6 | 0.64 | |||
COPD 3 | 1.75 | 0.7–4.4 | 0.23 | |||
Atrial fibrillation | 2.1 | 0.97–4.7 | 0.06 | |||
Hemodialysis | 1.9 | 0.34–10.7 | 0.46 | |||
In hospital characteristics | ||||||
ST-elevation MI | 2.09 | 1.1–4.0 | 0.025 | 2.3 | 1.1–4.7 | 0.02 |
LVEF 4 (per 1% increase) | 0.95 | 0.93–0.98 | 0.001 | 0.97 | 0.94–0.99 | 0.016 |
Multi-vessel disease | 3.1 | 1.7–5.8 | <0.001 | 3.4 | 1.7–6.6 | <0.001 |
Ventricular arrhythmia | 2.2 | 0.7–7.5 | 0.2 | |||
RBC 5 transfusion | 1.9 | 0.3–10.7 | 0.46 | |||
Pneumonia | 3.7 | 1.4– 9.6 | 0.008 | |||
GFR 6 (per 1 mL/min/1.73 m2 increase) | 0.9 | 0.98–1.0 | 0.09 |
Patients Surviving until Hospital Discharge (n = 190) | All Patients (n = 212) | |||||
---|---|---|---|---|---|---|
LOS 2 <8 Days (92 Patients) | LOS ≥8 Days (98 Patients) | p-Value | Higher-Risk (158 Patients) | Low-Risk (54 Patients) | p-Value | |
In hospital outcomes | ||||||
All-cause mortality (%) | - | - | - | 14 | 0 | 0.001 |
Cardiovascular mortality (%) | - | - | - | 14 | 0 | 0.001 |
All recurrent MI 1 (%) | 0 | 0 | - | 0 | 0 | - |
Non-fatal recurrent MI (%) | 0 | 0 | - | 0 | 0 | - |
All stroke (%) | 1 | 1 | 1.0 | 2 | 0 | 0.57 |
Non-fatal stroke (%) | 1 | 1 | 1.0 | 1 | 0 | 1.0 |
Combined endpoint (%) | 1 | 1 | 1.0 | 15 | 0 | 0.001 |
Long-term outcomes | ||||||
All-cause mortality (%) | 4 | 4 | 1.0 | 18 | 2 | 0.001 |
Cardiovascular mortality (%) | 0 | 2 | 0.5 | 15 | 0 | 0.001 |
All recurrent MI (%) | 11 | 7 | 0.45 | 8 | 9 | 0.77 |
Non-fatal recurrent MI (%) | 11 | 6 | 0.3 | 7 | 9 | 0.56 |
All stroke (%) | 2 | 2 | 1.0 | 4 | 0 | 0.34 |
Non-fatal stroke (%) | 2 | 2 | 1.0 | 2 | 0 | 0.57 |
Combined endpoint (%) | 12 | 10 | 0.82 | 24 | 9 | 0.02 |
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Węgiel, M.; Dziewierz, A.; Wojtasik-Bakalarz, J.; Sorysz, D.; Surdacki, A.; Bartuś, S.; Dudek, D.; Rakowski, T. Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice. J. Clin. Med. 2018, 7, 564. https://doi.org/10.3390/jcm7120564
Węgiel M, Dziewierz A, Wojtasik-Bakalarz J, Sorysz D, Surdacki A, Bartuś S, Dudek D, Rakowski T. Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice. Journal of Clinical Medicine. 2018; 7(12):564. https://doi.org/10.3390/jcm7120564
Chicago/Turabian StyleWęgiel, Michał, Artur Dziewierz, Joanna Wojtasik-Bakalarz, Danuta Sorysz, Andrzej Surdacki, Stanisław Bartuś, Dariusz Dudek, and Tomasz Rakowski. 2018. "Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice" Journal of Clinical Medicine 7, no. 12: 564. https://doi.org/10.3390/jcm7120564
APA StyleWęgiel, M., Dziewierz, A., Wojtasik-Bakalarz, J., Sorysz, D., Surdacki, A., Bartuś, S., Dudek, D., & Rakowski, T. (2018). Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice. Journal of Clinical Medicine, 7(12), 564. https://doi.org/10.3390/jcm7120564