Author + information
- Odunayo Olorunfemi1,
- Gbolahan Ogunbayo2,
- Anand Dayama3,
- Rebecca Ojo1,
- Amole Ojo4,
- Josephine Adunse1,
- Stone Melvin5 and
- John McNelis5
There is limited data on the utility of coronary stenting in patients who present to the hospital for trauma in the United States (US). Our study describes the occurrence, patterns and outcomes in patients who had received a stent during their hospital admission primarily for trauma over a 5-year period in the United States.
We identified all patients with the ICD-9 procedure codes for coronary artery stenting in the U.S. National Trauma Data Bank from 2008 to 2012. We described the patient characteristics, distribution of myocardial injury, time to diagnostic interventions and hospital outcomes.
Of the 3.65 million patients in the NTDB over our study period, 322 patients received a stent during their hospitalization which was primarily for trauma with a mean age of 68.1 [SD±12.8] years. 62.7% of them are females. Most [81.7%] of the patients had mild injuries [injury severity scores (ISS) less than 15]. Overall, 42 patients [13%] of the patients had a prior history of myocardial infarction (MI) among whom 23[7.1%] of the patients had their MI during the 6 months preceding their trauma admission and 3% reported angina in the 30 days before their hospitalization. Most [68.9%] of the patients had their stents placed in the first 72 hours of their hospitalization [early stenting] while the remainder was after 72 hours [late stenting]. There was a statistically significant difference in the total length of stay among the early vs late groups 11.8 days vs 12.9 days [p=0.010]. There was also a statistically significant difference in the length of ICU stay between those that underwent early stenting as compared with the late stenting group [ 7.2 vs 5.6 days ; p=0.044].
In multivariate regression there were higher odds for early stenting in patients with peripheral artery disease [OR 1.1] , in those with a prior MI in the 6 months before their admission [OR 1.3] and in those with an admission systolic blood pressure <70mmHg [OR 4.4] with p=0.931 ; p=0.693 ; and p= 0.317 respectively.
Our study shows that early coronary stenting appears to shorten the burden of a patient’s hospital and ICU length of stay. Our study also shows that patients with recent MI, peripheral artery disease and low admission blood pressures are likely candidates for coronary intervention after even a minor trauma event.