Aims
Acute coronary syndrome (ACS) is responsible for high rates of hospital admission with high cost burden. Knowing patients with projected prolonged length of stay (LOS) could enable clinicians to do early interventions and better preparations. This study aims to identify factors associated with prolonged LOS in ACS patients at the time of admission.
Method and Result
We included 237 ACS patients admitted to Kediri General Hospital and Bogor General Hospital between January and June 2020. Patients who died during hospitalization or discharged by their own will were excluded. Data were collected retrospectively and analyzed using SPSS v25. Prolonged LOS was defined as LOS more than 6 days. The mean age was 57.5±0.7 years, majority was male (65.8%) and had diagnosis of NSTE-ACS (56.5%). The median LOS was 5 days (2-23), and the prevalence of prolonged LOS was 18.1%. On bivariate analysis, factors associated with prolonged LOS were high risk age (men > 40 years and women > 50 years) (p = 0.01), hypotension (p < 0.01), decreased consciousness (p = 0.004), sign of shock (p = 0.002), tachycardia (p = 0.001), and higher Killip class (p = 0.002). After multivariable adjustment and stepwise elimination, hypotension was found to be significant independent predictor for prolonged LOS (OR 38.512 [95% CI 4.5-328], p = 0.001). The area under the receiver operating characteristic curve (AUC) was 0,704 (95% CI 0.614-0.794) which showed acceptable discrimination, and calibration was good (Hosmer-Lemeshow test: p = 0.96).
Conclusion
Hypotension was found to be strong independent predictor for prolonged LOS in ACS patients.
Background:In patients with acute coronary syndrome (ACS), the role of admission blood pressure (BP) on outcomes remains inconclusive.Objective:This study aimed to investigate the association between admission BP and various outcomes in patients hospitalized for ACS.Method:In this cross-sectional study, 279 patients who admitted with ACS to Kediri District Hospital and Bogor General Hospital between January and June 2020 were included. Data were analyzed using SPSS software v25.Result:There was association between hypertension status on admission and diagnosis; there were more hypertensive patients with non-ST segment elevation (NSTE) ACS compared to ST segment elevation (STE) ACS diagnosis (p = 0.002); and significant difference on admission systolic BP between STE-ACS and NSTE-ACS patients (p < 0.00001). Patients who died during hospitalization had significantly lower admission systolic BP compared to survived patients (p = 0.001). Patients with reduced ejection fraction (EF) on follow-up echocardiography had significantly lower admission systolic BP compared to patients with normal EF (p = 0.014). Patients with diastolic dysfunction on follow-up echocardiography had significantly higher admission systolic BP compared to patients without diastolic dysfunction (p = 0.009). No significant difference on length of stay between hypertensive and non-hypertensive patients (p = 0.416).Conclusion:Lower admission systolic BP was associated with increased in-hospital mortality and reduced EF, while higher systolic BP was associated with diastolic dysfunction.
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