Factors Associated with Increased Length of Stay in Post Primary Percutaneous Coronary Intervention Patients: A Scoping Review

Figures & data

Figure 1 PRISMA flow diagram.

Notes: PRISMA figure adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Creative Commons.³⁰

Table 1 Characteristics of Study

Author & Year	Method	Country	Mean Age	Sample	Findings			Critical Appraisal
					Average LOS	Category of LOS	Predictors of Increased LOS
[10]	Retrospective Study	Turkey	56.2	2.486	6 days	2 Category <6 days and >6 days	Anterior STEMI (OR 1.61; 95% CI 1.02–2.54) (p<0.001) Angiographic failure (OR 2.89; 95% CI 1.19–7.01) (p<0.001) PVC (OR 4.18; 95% CI 1.16–15.03) (p<0.001) Age >75 years (OR 1.76; 95% CI 1.25–2.49) (p=0.001) Female (OR 1.58; 95% CI 1.25–1.99) (p=0.001) Killip Class >1 (OR 4.68; 95% CI 2.60–8.42) (p<0.001) DM (OR 1.38; 95% CI 1.37–1.69) (p=0.001) HTN (OR 1.35; 95% CI 1.14–1.60) (p=0.001) Current smoker (OR 0.73; 95% CI 0.61–0.87) (p=0.001)	9/11
[22]	Retrospective Study	USA	73	33.920	4–5 days	3 Category <3 days, 4–5 days, and ≥5 days	Age (per 10-year increase) (OR 1.46; 95% CI 1.41–1.51) (p<0.001) Vascular complication (OR 3.88; 95% CI 2.88–5.22) (p<0.001) Bleeding complication (OR 2.61; 95% CI 2.30–2.95) (p<0.001) Male (OR 0.76; 95% CI 0.73–0.80) (p<0.001) Pre-procedural TIMI flow grade (p<0.001)*	9/11
[13]	Prospective Study	China	58.52	3.615	9 days	2 Category <7 days and >7 days	Age (per 1-year increase) (OR 1.01, 95% CI 1.00–1.01) (p<0.001) BMI (per 1kg/m2 increase) (OR 1.01, 95% CI 0.97–0.99) (p=0.042) HF (OR 5.59; 95% CI 1.58–19.71) (p<0.001) SBP (OR 0.99; 95% CI 0.99–0.99) (p=0.004) Killip Class>1 (OR 1.26; 95% CI 1.01, 1.57) (p=0.004) LVEF (per 1% increase) (OR 0.97; 95% CI 0.96–0.99) (p=0.001) Post-procedural TIMI Score (p=0.007)*	9/11
[34]	Cross-Sectional Study	Iran	59.36	561	3–6 days	3 Category ≤3 days, 3–6 days, and ≥6 days	Age (OR 0.9; 95% CI 0.81–1.00) (p=0.03) BMI (OR 1.56; 95% CI: 1.28–1.89) (p=0.016) Primary comorbidities (CKD, DM, HTN) (OR 1.75; 95% CI 1.35–2.27) (p=0.031) Post-procedure complications (OR 9.12; 95% CI: 7.22–11.53) (p<0.001) Problem at admission (OR 4.09; 95% CI 2.86–5.85) (p<0.001) Post-procedural TIMI Score (p<0.001)*	8/8
[23]	Prospective Observational Study	UK	63	467	4.5 days	N/I	LVEF (p<0.001)** Anterior STEMI (p<0.001)** Current Smoker (p=0.031)** Post-procedural TIMI Score (p=0.088)**	9/11
[20]	Retrospective Study	China	75.47	32	10.2 days	N/I	Patients with delirium have a longer LOS (p<0.000)**	8/11
[21]	Prospective Study	USA	62	20.339	7 days	N/I	Liver Cirrhosis patients had longer hospitalizations (p<0.001)*	8/11
[24]	Retrospective Study	USA	50	None	5.8 days	N/I	Gastrointestinal Bleeding (OR 2.62; 95% CI 2.40–2.92) (p<0.001)	7/11
[33]	Retrospective Study	Singapore	59	115,113	4 days	2 Category, ≤2 days and >2 days	Age (OR 1.08; 95% CI 1.07–1.08) (p<0.001) Female sex (OR 1.22; 95% CI 1.18–1.25) (p<0.001) DM (OR 1.41; 95% CI 1.32–1.50) (p<0.001) Any complication (OR 2.87; 95% CI 2.50–3.30) (p<0.001) Post-procedural TIMI Flow (p<0.001)	9/11
[35]	Retrospective Study	Taiwan	64.7	519	8.8 days	N/I	Gastrointestinal bleeding (p=0.04)*	8/11
[28]	Retrospective Study	Turkey	54.8	267	48 hours	4 Category, 24 hours, 48 hours, 72 hours, and > 72 hours	Multi-vessel disease (p<0.001)** Killip Classification 3 (p<0.001)**	8/11
[36]	Prospective observational study	Netherland	63.3	2.323	6.7 days	2 category, <6 days and >6 days	Post-procedural TIMI Score (p<0.001)* LVEF (OR 2.06; 95% CI 1.54–2.76) (p<0.001)	8/11
[37]	Retrospective Study	USA	59.6	678.545	3.3 days	3 category, <2 days, 2–3 days, >3 days.	Age (OR 1.01; 95% CI 1.06–1.14) (p<0.001) Female (OR 1.25; 95% CI 1.21–1.29) (p<0.001) Smoking (OR 0.80; 95% CI 0.78–0.83) (p<0.001) DM (OR 1.11; 95% CI 1.07–1.15) (p<0.001) Heart Failure (OR 3.06; 95% CI 2.90–3.23) (p<0.001) CKD (OR 1.17; 95% CI 1.09–1.26) (p<0.001) AKI (OR 3.00; 95% CI 2.77–3.24) (p<0.001) Vascular Complication (OR 2.47; 95% CI 2.10–2.90) (p<0.001)	9/11

Notes: *Chi-Square test with Significant at p<0.05. **t-test with Significant at p<0.05.

Abbreviations: AKI, Acute kidney injury; BMI, Body mass index; CI, Confidence Interval; CKD, chronic kidney disease; DM, Diabetes Mellitus; HTN, Hypertension; LVEF, Left ventricular ejection fraction; LOS, Length of Stay; N/I, Not Information; OR, Odd Ratio; PVC, Peripheral Vascular Complication; SBP, Systolic blood pressure; STEMI, ST-Elevation Myocardial Infarction; UK, United Kingdom; USA, United States of America.

Table 2 Factors Associated with Increased LOS

Predictors	Highest Ratio OR (95% CI)	Lowest Ratio R (95% CI)	Category of Predictors	Author & Year
Age	1.76 (CI: 1.25–2.49)	0.9 (CI: 0.81–1.00)	Low	[10,13,19,22,33,37]
Gender
Female	1.58 (CI: 1.25–1.99)	1.58 (CI: 1.25–1.99)	Low	[10,33,37]
Male	0.76 (CI: 0.73–0.80)	0.76 (CI: 0.73–0.80)	Low	[22]
BMI	1.56 (CI: 1.28–1.89)	1.01 (CI: 0.97–0.99)	Low	[13,34]
Complication
Vascular Complication	4.18 (CI: 1.16–15.03)	2.47 (CI 2.10–2.90)	High	[10,22,37]
Angiographic Failure	2.89 (CI: 1.19–7.01)	2.89 (CI: 1.19–7.01)	Moderate	[10]
Bleeding	2.62 (CI: 2.40–2.92)	2.61 (CI: 2.30–2.95)	Moderate	[22,24,35]
Post-procedure Complications	9.12 (CI: 7.22–11.53)	2.87 (CI 2.50–3.30)	High	[19,33]
AKI	3.00 (CI 2.77–3.24)	3.00 (CI 2.77–3.24)	Moderate	[37]
Delirium	P<0.001**	P<0.001**	Uncategorised	[20]
LVEF	2.06 (CI 1.54–2.76)	0.97 (CI; 0.96–0.99)	Moderate	[13,23,36]
Comorbid Disease
DM	1.75 (CI: 1.35–2.27)	1.11 (CI 1.07–1.15)	Low	[10,19,33,37]
HTN	1.35 (CI: 1.14–1.60)	0.99 (CI:0.99–0.99)	Low	[10,13,19]
CKD	1.75 (CI: 1.35–2.2)	1.17 (CI 1.09–1.26)	Low	[19,37]
Heart Failure	5.59 (CI: 1.58–1.97)	3.06 (CI 2.90–3.23)	High	[13,37]
Liver Cirrhosis	p<0.001*	p<0.001*	Uncategorised	[21]
Multi-vessel Disease	p<0.001**	p<0.001**	Uncategorised	[28]
Killip Class >1	4.68 (CI: 2.60–8.42)	1.26 (CI: 1.01–1.57)	High	[10,13,28]
Current Smoker	0.80 (CI 0.78–0.83)	0.73 (CI 0.61–0.87)	Low	[10,23,37]
Infarction Area
Anterior STEMI	1.61 (CI: 1.02–2.54)	1.61 (CI: 1.02–2.54)	Low	[10,23]
Problem at admission	4.09 (CI: 2.86–5.85)	4.09 (CI: 2.86–5.85)	High	[34]

Notes: *Chi-Square test with Significant at p<0.05.**t-test with Significant at p<0.05.

Abbreviations: AKI, Acute kidney injury; BMI, Body mass index; CI, Confidence Interval; CKD, chronic kidney disease; DM, Diabetes Mellitus; HTN, Hypertension; LVEF, Left ventricular ejection fraction; OR, Odd Ratio; STEMI, ST-Elevation Myocardial Infarction.

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