High Myocardial Oxygen Demand Index as a poor predictor of prolonged length of stay in patient with acute ischemic stroke in an Indonesian regional referral hospital: A single center study

Background. The double product (DP) acts as an index for myocardial oxygen demand, derived from the multiplication of systolic blood pressure (SBP) and pulse rate (PR). This research aimed to explore the association between high myocardial oxygen demand and extended hospital stays among acute ischemic stroke patients in Indonesia. Methods. This study was a retrospective cohort study carried out from January 2022 to December 2022 at a regional referral hospital located in Jakarta, Indonesia. Participants were chosen consecutively until the necessary sample size was achieved. Information extracted from medical records encompassed baseline sociodemographic and clinical variables. Univariate and bivariate analyses were performed, along with multivariate analysis utilizing Cox proportional hazards, to determine the correlation between elevated myocardial oxygen demand index and length of hospital stay (LOS). Results. A total of 366 patients were included, with a mean age of 60.05 ± 10.41 years, and 60.4% were male. The mean length of hospital stay was 3.4 ± 3.55 days. Bivariate analysis revealed a significant association between high myocardial oxygen demand index (RR 3.184, 95% CI 1.097-9.258, p=0.028), sepsis (RR 1.942, 95% CI 1.024-4.145, p=0.045), and severe anemia (RR 2.610, 95% CI 1.291-1.465, p=0.036) with prolonged length of stay. Multivariate analysis demonstrated that the high myocardial oxygen demand group had a significantly higher association with prolonged length of stay compared to the normal-to-low myocardial oxygen demand group (RR 2.116, 95% CI , p=0.035) after controlling for sepsis and severe anemia variables. Conclusions. The High Myocardial Oxygen Demand Index is significantly correlated with extended length of stay among patients with acute ischemic stroke, both before and after adjusting for other potential covariates that could impact treatment duration in such patients.