VOL. 65, NO. 12, 2015


ISSN 0735-1097/$36.00



Balloon-to-Door Time Emerging Evidence for Shortening Hospital Stay After Primary PCI for STEMI* Frederic S. Resnic, MD, Sachin P. Shah, MD


early 250,000 patients have an ST-segment

power of 5 days) were older, had more

relevant to the contents of this paper to disclose.








Resnic and Shah

JACC VOL. 65, NO. 12, 2015 MARCH 31, 2015:1172–4

Shortening Hospital Stays After STEMI PCI

multivessel coronary disease or cardiogenic shock

(representing patients with a same-day or next-day

compared with patients with a medium (4 to 5 days)

discharge). These 1,244 patients had a 30-day mor-

or short (#3 days) LOS. Compared with a short LOS,

tality rate twice that of patients discharged after 3 to

patients with a long LOS had a higher 30-day mor-

4 days of hospitalization. These results are intriguing,

tality rate (unadjusted 0.9% vs. 3.5%, respectively).

but they may simply highlight the limitations of the

These findings are not unexpected. Differences in

dataset analyzed. This group of patients represents

baseline characteristics or differences in the severity

only 3.7% of the entire study population. In addition,

of and complications related to myocardial infarction

just as confounders such as comorbidities and

are likely to have driven the major adverse cardio-

severity of illness are likely to affect mortality in pa-

vascular event (MACE) and mortality rates, as well as

tients with a very long LOS, certain confounders may

the LOS. These investigators attempted to adjust for

also play a role in patients with a very short LOS.

differences in severity of illness and comorbidities,

Patients leaving against medical advice or patients

but undoubtedly unmeasured confounders exist. The

transferred to another health care facility (potentially

principal finding of this observational study, even

as a result of clinical instability) comprise potential

with the limitations noted, was that there appeared to

factors that may increase the risk profile of the cohort

be no difference in 30-day mortality and MACE be-

with a very short LOS. These limitations significantly

tween patients with a short (#3 days) LOS and pa-

affect the ability to make any conclusions about this

tients with a medium (4 to 5 days) LOS.

small subset of patients discharged after a very short

An additional important finding is the significant



Unfortunately, the lack of a large randomized trial

seemed to affect LOS. Smaller hospitals and those in

assessing the safety of an early discharge after pri-

the West and Midwest regions of the United States

mary PCI for STEMI leaves clinicians with incomplete

were much more likely to have a short LOS. Specif-

evidence with which to make decisions. The paper

ically, 35% of patients in the West compared with

by Swaminathan et al. (16) helps affirm that the

only 16% of patients in the Northeast had a short

current practice to discharge lower-risk patients

LOS. This variation in practice may provide an

early (#3 days) is likely as safe as longer hospital

opportunity for a substantial reduction in resource

stays. Given the observed geographic variation, there

utilization at those hospitals and regions with a

is probably an opportunity to apply this practice





generally longer LOS after primary PCI for STEMI.

more broadly, thereby achieving significant health

Although clinical outcomes and quality must be

care cost savings while maintaining the quality of

carefully monitored with such change in practice, the

STEMI care.

adjusted analysis by Swaminathan et al. (16) indicates that such outcomes can be achieved with a shorter



Frederic S. Resnic, Department of Cardiovascular







Medicine, Lahey Hospital and Medical Center, 41 Mall

examine the mortality rates in a small subset of pa-


tients who were hospitalized for 1 to 2 days

[email protected].





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Shortening Hospital Stays After STEMI PCI

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KEY WORDS length of stay, percutaneous coronary intervention, ST-segment elevation myocardial infarction

Balloon-to-door time: emerging evidence for shortening hospital stay after primary PCI for STEMI.

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