LENGTH OF HOSPITAL STAY AND COMPLICATIONS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY CLINICAL AND PROCEDURAL PREDICTORS

Background Although several studies have established that the complica tions of percutaneous transluminal coronary angioplasty (PTCA) are rel ated to clinical and angiographic variables such as advanced age and l esion complexity, it is uncertain whether the use of hospital resource s after PTCA also depends on the same baseline variables. The purpose of this study was to identify the factors responsible for prolonged ho spital stay after PTCA. Methods and Results The study cohort included 591 consecutive patients undergoing conventional balloon angioplasty a t nine medical centers in North America. Major or minor complications occurred in 91 patients (15.4%) and were observed to be related to sev eral baseline characteristics, including unstable angina, multivessel coronary artery disease, patient age, and lesion complexity. Compared with a median length of hospital stay of 2.0 days after PTCA (25th, 75 th percentiles: 2.0, 4.0) for the entire cohort of patients, the lengt h of stay was increased in patients with unstable angina (3.0 days [2. 0, 5.0]; P=.002), multivessel coronary artery disease (3.0 [2.0, 5.5]; P=.001), age >65 years (3.0 [2.0, 5.5]; P=.02), complex lesions (3.0 [2.0, 6.0]; P=.001), and filling defects (6.0 [2.0, 11.0]; P<.001). Th e length of stay was more strikingly increased, however, in patients w ho experienced major or minor PTCA complications, such as emergency by pass surgery (9.0 days [8.0, 18.0]; P<.001), Q-wave or non-Q-wave myoc ardial infarction (8.0 [6.0, 15.5]; P<.001), transfusion unrelated to bypass surgery (8.0 [4.0, 12.0]; P<.001), or abrupt vessel closure (6. 0 [3.0, 10.5]; P<.001). On stepwise multiple linear regression, PTCA c omplications appeared to be the strongest predictors of length of hosp ital stay (all P<.001) and overwhelmed the weaker relation between len gth of stay and several individual baseline variables. Inclusion of a composite clinical risk score (reflecting the presence of unstable ang ina, multivessel disease, advanced age, complex lesions, or filling de fects) in the regression model confirmed that patients with several hi gh-risk baseline variables had a significant increase in length of sta y after PTCA (P=.003), but PTCA complications remained the strongest p redictors of length of stay. Conclusions Although PTCA complications w ere correlated with baseline Variables such as unstable angina, multiv essel disease, advanced age, complex lesions, and filling defects, exc ess length of stay after PTCA was most strongly influenced by the deve lopment of minor and major PTCA complications. Because patients with s everal baseline risk factors experienced significantly prolonged hospi talizations, improved selection of patients may contribute to reductio ns in length of stay after PTCA. A greater reduction in resource use a fter PTCA, however, would be expected from developing new treatments t o decrease PTCA complications rather than limiting the access of patie nts with unstable angina, advanced age, or complex lesions to PTCA.