title: Hospital length of stay and clinical outcomes in older STEMI patients after primary PCI: a report from the National Cardiovascular Data Registry.
abstract: BACKGROUND
  There has been a decline in hospital length of stay (LOS) after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  The objective of this study was to examine whether shorter LOS is safe for older patients undergoing PPCI for STEMI.
  
  
  METHODS
  The study analyzed patients' characteristics and 30-day outcomes by LOS (short, ≤3 days; medium, 4 to 5 days; long >5 days; where LOS was the discharge date minus the admission date plus 1) among 33,920 patients with STEMI in the linked CathPCI Registry-Centers for Medicare & Medicaid Services dataset who were ≥65 years of age and treated with PPCI from 2004 to 2009.
  
  
  RESULTS
  Percents of patients in each category were as follows: 26.9%, 46.3%, and 26.8% for short, medium, and long LOS, respectively. Patients with a long LOS were generally older, female, and had more comorbidities, including cardiogenic shock and multivessel disease. Patients with a short LOS generally had higher ejection fraction and single-vessel disease. There was no significant difference in 30-day all-cause mortality (hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.74 to 1.34) or major adverse cardiac events (MACE) (death, readmission for myocardial infarction, unplanned revascularization: HR: 1.03; 95% CI: 0.86 to 1.25) for medium versus short LOS. There was a significant increase in adjusted mortality (HR: 2.30; 95% CI: 1.72 to 3.07) and MACE (HR: 1.75; 95% CI: 1.44 to 2.12) for long versus short LOS. Patients with a very short LOS (1 to 2 days) had significantly increased 30-day mortality and MACE compared with a 3- to 4-day LOS.
  
  
  CONCLUSIONS
  Patients discharged as early as 48 h after PPCI have outcomes similar to patients who stay in the hospital for 4 to 5 days. Early, but not very early (<48 h), discharge may be safe among selected older patients with STEMI.
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York. Electronic address: rvs9001@med.cornell.edu.
authors: Rajesh V
authors: RV
authors: Swaminathan
authors: Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: Sunil V
authors: SV
authors: Rao
authors: Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: Lisa A
authors: LA
authors: McCoy
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: Luke K
authors: LK
authors: Kim
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: Robert M
authors: RM
authors: Minutello
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: S Chiu
authors: SC
authors: Wong
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: David C
authors: DC
authors: Yang
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors: Paramita
authors: P
authors: Saha-Chaudhuri
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: Harsimran S
authors: HS
authors: Singh
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: Geoffrey
authors: G
authors: Bergman
authors: Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, New York.
authors: Dmitriy N
authors: DN
authors: Feldman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D009657:North Carolina; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D011379:Prognosis; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: ST-segment elevation myocardial infarction; length of stay; myocardial infarction; older patients; outcomes; primary percutaneous coronary intervention