Predictors of major in-hospital ischemic complications and length of hospital stay after coronary stenting

Stefano De Servi, Sergio Repetto, Irene Bossi, Antonio Colombo, Silvio Klugmann, Antonio Bartorelli, Roberto Piva, Luigi Niccoli, Paolo Rubartelli, Luigi Giommi, Corrado Vassanelli, Giovanni Baduini, Raffaello Chioin, Francesco Bedogni, Alessandro Fontanelli, Aleardo Maresta, Carmelo Cernigliaro, Silvia Geraci

Research output: Contribution to journalArticle

Abstract

Although recent data show that coronary stenting reduces procedural complications and late restenosis, major concern has been expressed about the greater hospital cost associated with the use of this device as compared to conventional coronary angioplasty. Since length of hospital stay after surgical procedures is a major determinant of resource use, the identification of variables associated with an excessively long hospital stay after intracoronary stent placement may have important practical consequences. The purpose of this study was to assess factors responsible for the occurrence of in-hospital complications and prolonged hospital stay after coronary stenting in 939 consecutive patients enrolled in the Registro Impianto Stent Endocoronarico (RISE Study Group). Consecutive patients undergoing coronary stent implantation at 76 medical centers in Italy were prospectively enrolled in the Registry. Clinical data, qualitative and quantitative angiographic findings were obtained from date collected in case report forms at each investigator site. Major ischemic complications were considered death, Q-wave myocardial infarction, emergency bypass surgery and emergency repeat angioplasty. The study group consisted of 939 patients (781 men, 158 women with a mean age of 59 years) in whom 1392 stents were implanted in 1006 lesions and expanded at a maximal inflation pressure of 14.7 ± 3 atmospheres. The great majority of patients (92%) received only antiplatelet drugs after coronary stenting. During hospitalization, there were 45 major ischemic complications in 39 patients (4.2%): 13 events were related to acute or subacute thrombosis (1.4%). On multivariate logistic regression analysis, the following factors were predictive of in-hospital complications: increasing age (OR 2.19, 95% CI 1.78-4.07), unplanned stenting (OR 3.46, 95% Cl 1.65-7.23) and maximal inflation pressure (OR 0.83, 95% Cl 0.75-0.93). Mean hospital stay after stent implantation was 4.1 ± 4.4 days end was related, by multivariate regression analysis, to female sex (p = 0.0001), prior bypass surgery (p = 0.03), non-elective stenting (p = 0.0001), use of anticoagulation (p = 0.0001) and development of major ischemic complications (p = 0.0001). This Registry shows that in an unselected population of patients undergoing coronary stenting, major ischemic complications occur at a relatively low rate (4.2%) and thrombotic events can be kept at 1.4%, despite the omission of anticoagulation in the great majority of patients. Length of hospital stay was affected by the occurrence of major ischemic complications, unplanned stenting, use of anticoagulation, female sex and prior bypass surgery. Accumulating experience, further reduction in complications and complete omission of anticoagulation may decrease length of hospital stay, thus reducing the use of resources after coronary stenting.

Original languageEnglish
Pages (from-to)1345-1353
Number of pages9
JournalGiornale Italiano di Cardiologia
Volume28
Issue number12
Publication statusPublished - Dec 1998

Keywords

  • Coronary stent
  • PTCA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Predictors of major in-hospital ischemic complications and length of hospital stay after coronary stenting'. Together they form a unique fingerprint.

  • Cite this

    De Servi, S., Repetto, S., Bossi, I., Colombo, A., Klugmann, S., Bartorelli, A., Piva, R., Niccoli, L., Rubartelli, P., Giommi, L., Vassanelli, C., Baduini, G., Chioin, R., Bedogni, F., Fontanelli, A., Maresta, A., Cernigliaro, C., & Geraci, S. (1998). Predictors of major in-hospital ischemic complications and length of hospital stay after coronary stenting. Giornale Italiano di Cardiologia, 28(12), 1345-1353.