Clinical InvestigationInterventional CardiologyTrends and predictors of length of stay after primary percutaneous coronary intervention: A report from the CathPCI Registry
Section snippets
The CathPCI Registry database
The CathPCI Registry is co-sponsored by the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.11 Briefly, participating sites submit complete information from consecutive interventional cases performed at their center. Data collected includes patient characteristics, clinical features, angiographic and procedural details, and inhospital outcomes. Data quality is maintained by various measures such as rigorous and uniform data abstraction training,
Patient population
A total of 189,132 patients from 985 CathPCI Registry sites admitted with STEMI underwent PPCI from February 2004 through March 2009. After the exclusions, the final analysis population consisted of 115,113 patients enrolled from 980 hospitals (Figure 1).
Distribution of LOS
The distribution of LOS was skewed with a median LOS of 3 days (interquartile range, 2-4 days), and mean LOS 4.1 ± 4.7 days (Figure 2). Most patients (90%) were discharged within 6 days.
Mean LOS decreased significantly from January 2005 through
Discussion
Length of stay is an important determinant of overall health care costs and is therefore highly relevant in the current climate of increasingly finite medical resources. We examined data from a large contemporary population of STEMI patients undergoing PPCI in the United States. This study demonstrates that the average LOS has modestly, yet significantly, decreased between 2004 and 2009. This decline has occurred simultaneously with the predicted inhospital mortality risk of patients undergoing
Conclusion
In this large contemporary database of STEMI patients who have undergone PPCI, mortality risk has remained constant between 2004 and 2009, whereas there has been a modest but significant decrease in LOS. There exists considerable variation among hospitals in discharging low-risk and uncomplicated patients early. Length of stay ≤2 days is associated with specific patient, procedure, and hospital factors. The decrease in LOS may relate to improved procedural approaches and successes, but the
Acknowledgements
The authors would like to thank Erin LoFrese for her editorial contributions to this manuscript. Ms. LoFrese did not receive compensation for her assistance, apart from her employment at the institution where this study was conducted.
References (16)
- et al.
Procedural success versus clinical risk status in determining discharge of patients after primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score
J Am Coll Cardiol
(2005) - et al.
Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II investigators. Primary angioplasty in myocardial infarction
J Am Coll Cardiol
(1998) - et al.
International differences in evolution of early discharge after acute myocardial infarction
Lancet
(2004) - et al.
Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials
Am Heart J
(2009) - et al.
Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry
JACC Cardiovasc Interv
(2008) - et al.
The American College Of Cardiology–National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository
J Am Coll Cardiol
(2001) - et al.
Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry
J Am Coll Cardiol
(2010)
Cited by (0)
Stephen G. Ellis, MD served as guest editor for this article.
This project was supported by grant number U18HS016964 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. The funding source had no role in the design or implementation of the study, or in the decision to seek publication.