Etiologies, trends, and predictors of readmission in ST‐elevation myocardial infarction patients undergoing multivessel percutaneous coronary intervention

Abstract

Background Recent trials have shown benefits with percutaneous coronary intervention (PCI) on nonculprit coronary vessels in select ST‐elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (CAD). However, readmission rates and causes in this high‐risk group are unknown. Objective of this study is to explore pattern, causes and factors associated with 30‐day readmission after multivessel PCI in STEMI patients. Methods and Results Nationwide Readmissions Data (NRD) between 2010 and 2014 was utilized to identify multivessel PCI cases in STEMI patients using appropriate ICD‐9 codes. We evaluated 30‐day readmission rate and factors associated with 30‐day readmission. Hierarchical logistic regression model was used to identify factors associated with 30‐day readmission. Among 22,257 STEMI patients who survived to discharge after multivessel PCI, 2,302 (10.3%) were readmitted within 30‐days. Subsequent unresolved/aggravated cardiac issues most commonly triggered readmission (62.66%). Among cardiac causes, heart failure and ischemic heart disease were most frequent etiologies. Advancing age (OR: 1.073, 95%CI: 1.026 to 1.122, p = .002), female sex (OR: 1.36, 95%CI: 1.23 to 1.50, p < .001), comorbid conditions like chronic kidney disease (CKD; OR: 1.35, 95%CI: 1.17 to 1.57, p = .001), congestive heart failure (CHF; OR: 1.40, 95%CI: 1.24 to 1.57, p = .04), anemia (OR: 1.16, 95%CI: 1.002 to 1.34, p = .04), and utilization of a mechanical circulatory support (MCS) device (OR: 1.45, 95%CI: 1.19 to 1.77, p < .001) during the index procedure were predictive of subsequent readmission within 30 days. Conclusion In this large nationally representative study, nearly one in 10 patients were readmitted within 30 days from discharge after index admission for multivessel PCI in STEMI, most commonly for cardiac causes.

Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation

“…We identified in total 11 725 index admissions. Similar methods were used previously 12–16 . Patients who were readmitted to the hospital within 30 days within the same calendar year were further evaluated (n = 1911).…”

Current trends in utilization of fibrinolytic‐based reperfusion strategies and bleeding outcomes in ST‐elevation myocardial infarction

“…The National Inpatient Sample (NIS) database was utilized for years 2009-2016 to identify STEMI patients who had FT using international classification of disease (ICD)-Ninth and Tenth revision codes. 3 Pre-existing comorbidities were identified using algorithms from the healthcare cost and utilization project comorbidity software.…”

In STEMI, more stenting = less readmissions?

“…In this issue of Catheterization and Cardiovascular Interventions, Tripathi et al analyze data from an administrative database on 22,257 hemodynamically stable ST‐elevation myocardial infarction (STEMI) patients who underwent multivessel percutaneous coronary intervention (PCI) between 2010 and 2014 . Readmission within 30 days of discharge occurred in 10.3%.…”