open access

Vol 15, No 6 (2020)
Research paper
Published online: 2020-11-30
Get Citation

Cardiac, non-cardiac complications and predictors of prolonged hospital stay in non-diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Marta Migała, Justyna Chałubińska-Fendler, Marzenna Zielińska
DOI: 10.5603/FC.a2020.0056
·
Folia Cardiologica 2020;15(6):398-406.

open access

Vol 15, No 6 (2020)
Original Papers
Published online: 2020-11-30

Abstract

Introduction. Prolonged patient stay after acute myocardial infarction (MI) results in higher costs. This study evaluated factors prolonging hospitalization after admission due to MI. Complications which also influence on longer hospital stay: both cardiac (CC) and non-cardiac (NCC), were analysed. Material and methods. The authors included prospectively 131 patients with MI undergoing primary percutaneous intervention. Following factors were collected: demographic and anthropomorphic data, types of infarction, 12-lead electrocardiography (ECG), echocardiography, standard blood tests including admission blood glucose level, fasting glycaemia, oral glucose tolerance test (OGTT) at discharge as well as renal filtration and lipid parameters. Length of hospital stay of < 6 days or longer, the occurrence of CC and NCC were analysed. Results. The mean age of patients was 62 ± 10.9 years, 71.8% were male. Factors which correlated significantly with longer hospitalisation were: older age (R = 0.47, p = 0.001), higher fasting glycaemia (R = 0.25, p = 0.027), reduced left ventricular ejection fraction (LVEF) (R = –0.36, p = 0.04), occurrence of ST-elevation MI (p = 0.0166), presence of CC (p = 0.0007) and NCC (p = 0.0001). Age, high blood glucose in OGTT and LVEF remained significant in a multivariate model predicting the duration of stay (R2 = 0.32). Factors predicting hospital stay ≥ 6 days in the multivariate model were: older age (p = 0.000), hip circumference (p = 0.014), anterior wall MI (p = 0.026) and usage of glycoprotein IIb/IIIa inhibitors (p = 0.022) with and area under the receiver operating characteristic curve (ROC): 0.792 [95% confidence interval (CI) 0.71–0.87] with specificity 71% and sensitivity 79%. Factors influencing CC occurrence in the multivariate model were: estimated glomerular filtration rate (p = 0.009), LVEF (p = 0.003) with ROC 0.735 (95% CI 0.65–0.82) with specificity 76% and sensitivity 60%. Factors influencing the occurrence of NCC were hyperlipidaemia (p = 0.021), and LVEF (p = 0.004) with an ROC: 0.792 (95% CI 0.71–0.87) with specificity 55% and sensitivity 90%. Conclusions. LVEF, age and blood glucose levels significantly prolonged hospital stay. The major factor associated with an increased risk of both CCs and NCCs was LVEF.

Abstract

Introduction. Prolonged patient stay after acute myocardial infarction (MI) results in higher costs. This study evaluated factors prolonging hospitalization after admission due to MI. Complications which also influence on longer hospital stay: both cardiac (CC) and non-cardiac (NCC), were analysed. Material and methods. The authors included prospectively 131 patients with MI undergoing primary percutaneous intervention. Following factors were collected: demographic and anthropomorphic data, types of infarction, 12-lead electrocardiography (ECG), echocardiography, standard blood tests including admission blood glucose level, fasting glycaemia, oral glucose tolerance test (OGTT) at discharge as well as renal filtration and lipid parameters. Length of hospital stay of < 6 days or longer, the occurrence of CC and NCC were analysed. Results. The mean age of patients was 62 ± 10.9 years, 71.8% were male. Factors which correlated significantly with longer hospitalisation were: older age (R = 0.47, p = 0.001), higher fasting glycaemia (R = 0.25, p = 0.027), reduced left ventricular ejection fraction (LVEF) (R = –0.36, p = 0.04), occurrence of ST-elevation MI (p = 0.0166), presence of CC (p = 0.0007) and NCC (p = 0.0001). Age, high blood glucose in OGTT and LVEF remained significant in a multivariate model predicting the duration of stay (R2 = 0.32). Factors predicting hospital stay ≥ 6 days in the multivariate model were: older age (p = 0.000), hip circumference (p = 0.014), anterior wall MI (p = 0.026) and usage of glycoprotein IIb/IIIa inhibitors (p = 0.022) with and area under the receiver operating characteristic curve (ROC): 0.792 [95% confidence interval (CI) 0.71–0.87] with specificity 71% and sensitivity 79%. Factors influencing CC occurrence in the multivariate model were: estimated glomerular filtration rate (p = 0.009), LVEF (p = 0.003) with ROC 0.735 (95% CI 0.65–0.82) with specificity 76% and sensitivity 60%. Factors influencing the occurrence of NCC were hyperlipidaemia (p = 0.021), and LVEF (p = 0.004) with an ROC: 0.792 (95% CI 0.71–0.87) with specificity 55% and sensitivity 90%. Conclusions. LVEF, age and blood glucose levels significantly prolonged hospital stay. The major factor associated with an increased risk of both CCs and NCCs was LVEF.
Get Citation

Keywords

myocardial infarction (MI), length of stay, complications

About this article
Title

Cardiac, non-cardiac complications and predictors of prolonged hospital stay in non-diabetes patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Journal

Folia Cardiologica

Issue

Vol 15, No 6 (2020)

Article type

Research paper

Pages

398-406

Published online

2020-11-30

DOI

10.5603/FC.a2020.0056

Bibliographic record

Folia Cardiologica 2020;15(6):398-406.

Keywords

myocardial infarction (MI)
length of stay
complications

Authors

Marta Migała
Justyna Chałubińska-Fendler
Marzenna Zielińska

References (25)
  1. Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  2. Węgiel M, Dziewierz A, Wojtasik-Bakalarz J, et al. Hospitalization length after myocardial infarction: risk-assessment-based time of hospital discharge vs. real life practice. J Clin Med. 2018; 7(12).
  3. Vavalle JP, Lopes RD, Chen AY, et al. Hospital length of stay in patients with non-ST-segment elevation myocardial infarction. Am J Med. 2012; 125(11): 1085–1094.
  4. Ahmed F, Rahman A, Rahman M, et al. Predictors of short term outcomes of primary percutaneous coronary intervention. Bangladesh Heart J. 2018; 33(2): 112–120.
  5. Hirsch IB, O'Brien KD. How to best manage glycemia and non-glycemia during the time of acute myocardial infarction. Diabetes Technol Ther. 2012; 14 Suppl 1: S22–S32.
  6. Macín SM, Perna E, Coronel M, et al. Influence of admission glucose level on long-term prognosis in patients with acute coronary syndrome [Article in Spanish] . Rev Esp Cardiol. 2006; 59(12): 1268–1275.
  7. Moustafa TM. Utility of admission blood glucose level in prediction of short-term course and extent of coronary artery occlusion in non-diabetic patients with ST segment elevation myocardial infarction. IJC Metab Endocr. 2017; 14: 16–20.
  8. Zhao Cj, Hao Zx, Liu R, et al. Admission glucose and risk of early death in non-diabetic patients with ST-segment elevation myocardial infarction: a meta-analysis. Med Sci Monit. 2015; 21: 1387–1394.
  9. Foo K, Cooper J, Deaner A, et al. A single serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes. Heart. 2003; 89(5): 512–516.
  10. Aronson D, Hammerman H, Kapeliovich MR, et al. Fasting glucose in acute myocardial infarction: incremental value for long-term mortality and relationship with left ventricular systolic function. Diabetes Care. 2007; 30(4): 960–966.
  11. Vergès B, Zeller M, Dentan G, et al. Impact of fasting glycemia on short-term prognosis after acute myocardial infarction. J Clin Endocrinol Metab. 2007; 92(6): 2136–2140.
  12. Glucose abnormalities in patients with myocardial infarction: prevalence, diagnosis, and prognostic implications — GAMI. https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2010/02/23/19/06/GAMI (8 November, 2004).
  13. Bartnik M, Malmberg K, Norhammar A, et al. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur Heart J. 2004; 25(22): 1990–1997.
  14. Ponikowski P, Hoffman P, Witkowski A. ed. Kardiologia. Podręcznik Polskiego Towarzystwa Kardiologicznego. Via Medica, Gdańsk 2019: 212.
  15. Cosby RS. Late complications of myocardial infarction. JAMA. 1976; 236(15): 1717–1720.
  16. Kutty RS, Jones N, Moorjani N. Mechanical complications of acute myocardial infarction. Cardiol Clin. 2013; 31(4): 519–31, vii.
  17. Berger AK, Duval S, Jacobs DR, et al. Relation of length of hospital stay in acute myocardial infarction to postdischarge mortality. Am J Cardiol. 2008; 101(4): 428–434.
  18. Isik T, Ayhan E, Uluganyan M, et al. Predictors of prolonged in-hospital stay after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Angiology. 2016; 67(8): 756–761.
  19. Sharkawi MA, Filippaios A, Dani SS, et al. Identifying patients for safe early hospital discharge following st elevation myocardial infarction. Catheter Cardiovasc Interv. 2017; 89(7): 1141–1146.
  20. Tralhão A, Ferreira AM, Madeira S, et al. Applicability of the Zwolle risk score for safe early discharge after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Rev Port Cardiol. 2015; 34(9): 535–541.
  21. Grines CL, Marsalese DL, Brodie B, et al. Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. J Am Coll Cardiol. 1998; 31(5): 967–972.
  22. Pack QR, Mansour M, Barboza JS, et al. An early appointment to outpatient cardiac rehabilitation at hospital discharge improves attendance at orientation: a randomized, single-blind, controlled trial. Circulation. 2013; 127(3): 349–355.
  23. Laurencet ME, Girardin F, Rigamonti F, et al. Early discharge in low-risk patients hospitalized for acute coronary syndromes: feasibility, safety and reasons for prolonged length of stay. PLoS One. 2016; 11(8): e0161493.
  24. Kotowycz MA, Syal RP, Afzal R, et al. Can we improve length of hospitalization in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention? Can J Cardiol. 2009; 25(10): 585–588.
  25. Heran BS, Chen JMh, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011(7): CD001800.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl