title: Length of stay and long-term mortality following ST elevation myocardial infarction.
abstract: BACKGROUND
  Over the last few decades, there has been a significant reduction in hospital length of stay (LOS) among patients undergoing percutaneous intervention (PCI) for ST elevation myocardial infarction (STEMI). Although studies have looked at predictors of long hospital stay after STEMI, the impact of LOS on long-term outcomes after PCI remains unknown. We aimed to evaluate the association between LOS at the time of index hospitalization for PCI and long-term mortality among patients presenting with STEMI.
  
  
  METHODS
  We examined all patients undergoing PCI for STEMI at the Cleveland Clinic Catheterization Laboratory between 2002 and 2011. Long-term all-cause mortality was assessed using the Social Security Death Index and electronic medical record review. LOS was extracted from the discharge summary of the index hospitalization.
  
  
  RESULTS
  A total of 1,963 patients were included in the study. Of these 1,963 patients undergoing PCI for STEMI, 126 (6.4%) died during the index hospitalization. Among survivors of this hospitalization, we observed a significant increase in long-term mortality with an increase in LOS during index hospitalization (P < 0.001). Adjustment for demographic and clinical characteristics yielded statistically significant increased mortality among patients with LOS of 6-10 days [HR (95% CI): 2.2 (1.3-3.5)] and LOS > 10 days [HR (95% CI): 2.6 (1.6-4.3)], in comparison with patients with LOS of 1-2 days.
  
  
  CONCLUSIONS
  Long hospital stay after PCI among patients with STEMI was associated with an increased long-term mortality. A long hospital stay may be used as a marker to identify patients at higher risk for long-term mortality.
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Aatish
authors.initials: A
authors.lastname: Garg
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Sones Cardiac Catheterization Laboratories, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D009820:Ohio / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors
keywords: ST elevation myocardial infarction; length of stay; mortality