Clinical factors determining length of hospital stay in patients with acute coronary syndrome treated with two-stage percutaneous coronary intervention

Introduction Multivessel coronary artery disease (CAD) affects over half of patients with acute coronary syndrome (ACS). These patients, often elderly with multiple comorbidities, face an increased risk of complications, such as renal deterioration or anemia, especially when managed with two-stage percutaneous coronary intervention (PCI). Protracted hospitalization negatively impacts long-term prognosis. The specific factors for prolonged length of stay (LOS) in this high-risk group require clear definition to enable effective prevention. Objective To assess the factors determining protracted length of stay (LOS) in patients with acute coronary syndrome managed with two-stage percutaneous coronary intervention. Methods A retrospective cohort study analyzed 302 patients admitted due to myocardial infarction and treated with two-stage PCI between June 2020 and June 2022. Patients were stratified into two groups based on the median LOS: ≤5 days (n=191) and >5 days (n=111). Data included comorbidities, admission clinical status (Killip-Kimball), LVEF, laboratory parameters (hemoglobin, GFR, CRP), procedural details (access, contrast volume), and in-hospital complications (AKI, shock, infection). Multivariate logistic regression was used to identify independent risk factors for protracted hospitalization. Results The protracted stay group (median LOS: 8 days) compared to the shorter stay group (4 days) was significantly older (p<0.0001) and more frequently presented with chronic kidney disease, heart failure, diabetes, and atrial fibrillation. They had a worse clinical status (Killip-Kimball classification, p<0.0001), lower LVEF (p=0.014), lower hemoglobin, and higher CRP on admission. They also had a higher contrast volume index normalized to GFR (p<0.001) and experienced more complications, including acute kidney injury (AKI) (p<0.0001), cardiogenic shock, and hospital-acquired infection. Independent risk factors for protracted hospitalization in multivariate analysis were: Killip-Kimball classification (HR 2.36; p<0.001), age (HR 1.06; p<0.001), LVEF <50% (HR 2.23; p=0.009), atrial fibrillation (HR 2.48; p=0.011), anemia (HR 1.89; p=0.019), and femoral access (HR 5.10; p=0.004). Conclusions Protracted hospitalization in ACS patients undergoing two-stage PCI is multifactorial and strongly associated with various clinical complications. Independent predictors identified were: advanced age, severe clinical status on admission (Killip-Kimball), history of atrial fibrillation, LVEF <50%, anemia, and the use of percutaneous femoral vascular access.