The objective of this study is to construct a predictive model for prolonged hospital stay after PCI in AMI patients through retrospective analysis of postoperative data, and to validate the accuracy of the model’s predictions in an external population. The research findings indicate that female gender, smoking, hypertension, Killip classification of heart function, and elevated levels of high-sensitivity troponin T (hs-cTnT) are independent predictive factors for prolonged hospital stay after PCI in AMI patients.
This study reveals a significant correlation between gender and prolonged hospitalization time for patients undergoing PCI after acute myocardial infarction. Female patients experience a hospitalization period that is 4.13 times longer than male patients, which aligns with the findings of Pakdil et al[7]. The study indicates that compared to males, females are more likely to exhibit atypical symptoms such as atypical chest pain and angina, potentially leading to delayed medical attention[8]. Kaur et al.'s research reveals that the median time delay for seeking medical attention due to symptoms of acute myocardial infarction is 53.7 hours for females, compared to only 15.6 hours for males. Such delayed treatment may result in slower recovery for female patients[9]. Furthermore, studies indicate that female patients diagnosed with acute myocardial infarction are less likely to receive aggressive treatment strategies, and are more susceptible to the risks of bleeding and other complications[10]. These medical factors may account for the prolonged hospital stay observed in female patients.
Smoking is one of the foremost risk factors for cardiovascular diseases, including acute myocardial infarction[11]. A groundbreaking, multi-center and prospective study from the United States reveals that smoking is an independent risk factor that prolongs the hospitalization duration for patients with acute myocardial infarction[11].A meta-analysis conducted on PCI intervention reveals a correlation between smoking and an increased risk of overall mortality and heart failure[12]. This association may be attributed to the tendencies of smoking to induce platelet aggregation, elevate fibrinogen levels, and reduce fibrinolysis, resulting in a prothrombotic state that facilitates the formation of acute thrombosis[13].As is customary with most studies, smoking was defined based on baseline data, and there was no follow-up data during hospitalization, thus making it impossible to assess the impact of post-treatment smoking crossover.
Research indicates that individuals with hypertension have a higher likelihood of experiencing AMI compared to those without this condition. Additionally, it has been noted that AMI patients with a history of hypertension tend to have prolonged hospital stays and poorer prognosis[8, 14].Clinical studies revealed that the hypertension-induced reduction in circulating Tregs strongly correlated with the higher occurrence rate of microvascular obstruction in AMI patients with hypertension[15].Hypertension constitutes an independent influencing factor that prolongs the hospitalization duration for AMI patients. This can potentially be attributed to the ability of hypertension to induce atherosclerosis, exacerbate disease progression, and diminish treatment efficacy, thereby leading to an extended length of stay[16].
The Killip classification provides insights into the prognosis of patients suffering from AMI. A study was conducted to assess the prognostic value of Killip classification in patients presenting with acute myocardial infarction. A total of 6704 patients were included, and the findings revealed that patients with higher Killip classification had poorer clinical outcomes, longer hospital stays, and higher mortality rates. Additionally, higher Killip classification emerged as an independent predictor of mortality in acute myocardial infarction[17].A study conducted in China has demonstrated that the Killip classification is an independent predictive factor for the mortality rate or readmission of AMI patients at 6 months after discharge[18].In this study, the Killip classification emerged as an independent influential factor prolonging the post-PCI hospitalization time in patients with AMI, corroborating previous research findings. Patients with higher Killip grades exhibit more severe conditions and necessitate more intricate treatment plans, hence requiring an extended hospitalization period for comprehensive management and monitoring of their medical conditions.
High-sensitivity cardiac troponin T (hs-cTnT) serves as the primary biomarker for myocardial injury, with a significant release into the bloodstream following myocardial damage. It holds a higher diagnostic value in assessing myocardial cell injury, given its heightened sensitivity and specificity compared to conventional troponin assays. Moreover, hs-cTnT exhibits a longer diagnostic window period, especially in the early detection of minimal myocardial injury in patients with AMI[19].
Furthermore, an extended duration of hospitalization is considered an indicator of overall poorer health status. Previous studies have indicated a correlation between longer hospital stays and a history of conditions such as diabetes and stroke[20], as well as depression. Although the mechanisms remain unclear, there is also research suggesting that patient compliance with medical advice, medication adherence, and lifestyle habits are associated with longer hospital stays[21]. Therefore, future research should incorporate patients’ social and psychological characteristics. These findings can provide valuable insights for the development of psychosocial interventions and offer healthcare professionals alternative clinical care approaches.