Sixty-day readmission rate after percutaneous coronary intervention: predictors and impact on long-term outcomes

Early vs. Late Readmission following Percutaneous Coronary Intervention: Predictors and Impact on Long-Term Outcomes

BACKGROUND

Readmissions within 1 year after percutaneous coronary intervention (PCI) are common (18.6-50.4% in international series) and a burden to patients and health services, however their long-term implications are not well characterised. We compared predictors of 30-day (early) and 31-day to 1-year (late) unplanned readmission and the impact of unplanned readmission on long-term clinical outcomes post-PCI.

METHODS

Patients enrolled in the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from 2008 to 2020 were included in the study. Multivariate logistic regression analysis was performed to identify predictors of early and late unplanned readmission. A Cox proportion hazards regression model was used to explore the impact of any unplanned readmission during the first year post-PCI on the clinical outcomes at 3 years. Finally, patients with early and late unplanned readmission were compared to determine which group was at the highest risk of adverse long-term outcomes.

RESULTS

The study comprised 16,911 consecutively enrolled patients who underwent PCI between 2009-2020. Of these, 1422 patients (8.5%) experienced unplanned readmission within 1-year post-PCI. Overall, the mean age was 68.9 ± 10.5 years, 76.4% were male and 45.9% presented with acute coronary syndromes. Predictors of unplanned readmission included increasing age, female gender, previous CABG, renal impairment and PCI for acute coronary syndromes. Unplanned readmission within 1 year of PCI was associated with an increased risk of MACE (adjusted HR 1.84 (1.42-2.37), p < 0.001) and death over a 3-year follow-up (adjusted HR 1.864 (1.34-2.59), p < 0.001) compared with those without readmission within 1-year post-PCI. Late compared with early unplanned readmission within the first year of PCI was more frequently associated with subsequent unplanned readmission, MACE and death between 1 and 3 years post-PCI.

CONCLUSIONS

Unplanned readmissions in the first year following PCI, particularly those occurring more than 30 days after discharge, were associated with a significantly higher risk of adverse outcomes, such as MACE and death at 3 years. Strategies to identify patients at high risk of readmission and interventions to reduce their greater risk of adverse events should be implemented post-PCI.

Risk factors and prediction nomogram model for 1-year readmission for major adverse cardiovascular events in patients with STEMI after PCI

To identify risk factors and develop a risk-prediction nomogram model for 1-year readmission due to major adverse cardiovascular events (MACEs) in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). This was a single-center, retrospective cohort study. A total of 526 eligible participants were enrolled, which included 456 non-readmitted and 70 readmitted patients. Multivariate logistical regressions were performed to identify the independent risk factors for readmission, and a prediction nomogram model was developed based on the results of the regression analysis. The receiver operating characteristic curve, Hosmer-Lemeshow test, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Female (OR = 2.426; 95% CI: 1.395-4.218), hypertension (OR = 1.898; 95% CI: 1.100-3.275), 3-vessel disease (OR = 2.632; 95% CI: 1.332-5.201), in-hospital Ventricular arrhythmias (VA) (OR = 3.143; 95% CI: 1.305-7.574), peak cTnI (OR = 1.003; 95% CI: 1.001-1.004) and baseline NT-proBNP (OR = 1.001; 95% CI: 1.000-1.002) were independent risk factors for readmission (all P < 0.05). The nomogram exhibited good discrimination with the area under the curve (AUC) of 0.723, calibration (Hosmer-Lemeshow test; χ2 = 15.396, P = 0.052), and clinical usefulness. Female gender, hypertension, in-hospital VA, 3-vessel disease, baseline NT-proBNP, and peak cTnI were independent risk factors for readmission. The nomogram helped clinicians to identify the patients at risk of readmission before their hospital discharge, which may help reduce readmission rates.

Readmissions to Hospital After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Factors Associated with Readmissions

BACKGROUND

Readmissions after PCI are a burden to patients and health services that are not well understood.

METHODS

A systematic review was performed to identify studies of readmission after PCI. Readmission rates and causes of readmission were examined and factors associated with 30-day readmissions were combined using meta-analyses.

RESULTS

A total of 39 studies evaluated readmissions after PCI (6,569,690 patients, 31 studies). The 30-day readmission rate varied from 3.3%-15.8%. Beyond 30-days, the readmission rate was 6% at 2 months, 31.5% at 6 months, 18.6-50.4% at 12 months and 26.3-71% beyond 48 months. The pooled proportion of patients with cardiac cause for readmissions ranged from 4.6%-75.3%. The range of rates of 30-day readmissions for reinfarction/stent thrombosis, heart failure, chest pain and bleeding were 2.5%-9.5%, 5.9%-12%, 6.7-38.1% and 0.7-7.5%, respectively. Meta-analysis suggests that female gender (RR 1.25(1.20-1.30), I² = 65.2%), diabetes (RR 1.22(1.20-1.25), I² = 0%), heart failure (RR 1.43(CI 1.28-1.60), I² = 92.8%), renal failure (RR 1.50(1.45-1.55), I² = 0%), chronic lung disease (RR 1.34(1.26-1.44), I² = 87.5%), peripheral artery disease (RR 1.20(1.15-1.25), I² = 46.5%) and cancer (RR 1.35(1.15-1.58), I² = 72.8%) were associated with 30-day readmissions. The average cost of unplanned and all 30-day readmissions has been reported to be $12,636 and $17,576, respectively.

CONCLUSIONS

We estimate that 1 in 7 patients who undergo PCI are readmitted within 30-days and the rate can rise to up to 3 in 4 patients beyond 3 years. Interventions should be considered to reduce readmissions such as discharge checklists, evaluation of medication compliance at follow-up and prompt management when patients re-present to emergency department.

Comparison of outcomes in emergency department patients with suspected cardiac chest pain: two-centre prospective observational study in Southern China

BACKGROUND

Hong Kong (HK) and Guangzhou (GZ) are cities in China with different healthcare systems. This study aimed to compare 30-day and 6-month mortality and characteristics of patients with suspected cardiac chest pain admitted to two emergency departments (ED) in HK and GZ.

METHODS

A prospective observational study enrolled patients with suspected cardiac chest pain presenting to EDs in the Prince of Wales Hospital (PWH), HK and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU),GZ. The primary outcome was 30-day and 6-month mortality.

RESULTS

In total, 996 patients were recruited, 407 cases from GZ and 589 cases from HK.The 30-day and 6-month mortality of chest patients were 3.7% and 4.7% in GZand 0.3% and 1.9% in HK, respectively. Serum creatinine level (Cr) was an independent factor for 30-day mortality whilst Cr and systolic blood pressure (SBP) were independent factors for 6-month mortality. In Cox regression analysis, unadjusted and adjusted hazard ratios for 30-day and 6-month mortality in GZ were significantly increased.

CONCLUSION

The 30-day and 6-month mortality of patients with suspected cardiac chest pain in Guangzhou were higher than in Hong Kong due to due to different baseline clinical characteristics of patients and different distributions of diagnoses, which were associated with different healthcare systems. Serum creatinine and SBP were independent factors for 30-day and 6-month mortality.