Reducing Balloon-to-door Time, Assessment of Length of Hospital Stay after Acute-coronary-syndrome, Analysis from the ACSIS Database

Background: Current evidence regarding the optimal length of hospital stay (LOS) after a myocardial infarction (MI) is lacking and equivocal.

Objective: To examine the LOS policy for MI patients and to identify predictors for safe early discharge strategy.

Methods: A prospective observational study that included patients with STEMI and NSTEMI who were enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000-2016. Patients were divided into 3-subgroups according to their LOS: 6 days (long-LOS). We compared these groups for baseline characteristics, management strategies and clinical outcomes at 30-days and at 1-year.

Results: 13,458 patients were enrolled in the study. The LOS among MI patients had gradually shorten throughout the years. Short-LOS and intermediate-LOS patients had similar characteristics while patients in the long-LOS group were older with more co-morbidities.

There was no difference in the clinical outcomes between the short-LOS and intermediate-LOS groups, including re-MI (1.2% vs. 1.3%, p=0.72), angina (3.8% vs. 4%, p=0.82), arrythmias (0.39% vs. 0.3%, p=0.423), 30-days MACE (7% vs. 8.1%, p=0.15), 30-days mortality (0.7% vs. 0.7%, p=1.0) and 1-year mortality (4% vs. 3.5%, p=0.4). However, the rate of re-hospitalizations was higher in the short-LOS group (20.9% vs. 17.8%, p=0.004) mostly due to nonspecific complains without evidence of cardiovascular events.

In multivariate analysis, the LOS did not predict neither 30-days or 1-year mortality (HR:1.24; CI:0.53-3.6; HR:0.72; CI:0.52-1.02), nor MACE at 30-days (HR:0.94; CI:0.74-1.2),

Conclusion: Our study suggests that early discharge strategy, up to 3-days from admission, is safe for low and intermediate-risk patients (GRACE score< 115), for both STEMI and NSTEMI. It appears that there no true clinical benefit for hospitalization of ACS patients with uncomplicated course beyond 3-days, nevertheless there might be psychological and social factors that may warrant longer stay in order to avoid unnecessary re-admissions.