Stent versus Bypass: The reasons and risk factors for early readmission to hospital after myocardial revascularization

Abstract

OBJECTIVE:Though 30-day rates of readmission for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) remain high, readmission rates and associated risk factors have not been well examined. The purpose of the present study was to determine the risk factors for and rates of readmission and to compare two revascularization methods on that basis.METHODS:The study included 2664 consecutive patients who underwent coronary revascularization either with CABG surgery or PCI. The study was performed retrospectively and a wide variety of risk factors related to readmission were selected for analysis, including demographic data, preoperative risk factors and postoperative complications.RESULTS:From the CABG group (Group 1, n=1103), 18.3% were readmitted, as were 15.2% of the PCI group (Group 2, n=1561). In multivariate analysis, age, gender, left ventricular ejection fraction (LVEF), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), length of stay (>10 days), body mass index (BMI), and creatinine level on admission were associated with early readmission for group 1 (Table 3). In group 2, age, gender, LVEF, DM, length of stay (>10 days), and creatinine level on admission were associated with early readmission.CONCLUSION:When two methods of revascularization were compared, rates of readmission were found to be similar. Patients with cited risk factors are prone to readmission in the first 30 days, so extra precautions should be taken at discharge. Neither method can be concluded to be superior with regard to readmission rates.

Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

“…Forty studies [ 7 , 8 , 11 – 14 , 20 – 26 , 28 – 37 , 39 – 44 , 46 – 49 , 52 , 54 , 58 , 59 , 62 , 64 , 65 ] (75% of all included studies) were from the USA. Most studies [ 7 , 8 , 11 – 14 , 20 , 21 , 25 , 27 , 32 , 33 , 35 – 37 , 39 – 42 , 44 , 46 – 49 , 52 , 58 , 59 , 61 , 63 , 65 , 66 ] ( n = 31) were based on administrative data aggregated across multiple sites and 22 studies [ 22 – 24 , 26 , 28 – 31 , 34 , 38 , 43 , 45 , 50 , 51 , 53 – 57 , 60 , 62 , 64 ] used medical records from either a single center or multiple centers. The included studies varied widely in sample size (range: 110 to 1,116,991).…”

“…Twenty-three studies [ 8 , 13 , 28 , 31 , 35 , 36 , 39 – 41 , 43 , 46 , 48 , 50 , 52 , 54 , 55 , 57 , 58 , 60 , 62 – 64 , 66 ] reported the causes of 30-day readmission after CABG (Fig. 4 ).…”

The impact of type 2 diabetes mellitus on prognosis in patients with non-ST elevation myocardial infarction

“…Sargin et al compared the frequency of rehospitalization after myocardial revascularization [ 26 ]. Their study included 2664 patients with coronary heart disease, who were divided into two groups: group 1 included patients treated with CABG (1103 patients), and group 2 was constituted by patients undergoing PCI (1561 patients).…”

Main predictors of in-hospital adverse outcomes in non-ST elevation acute coronary syndrome patients with multivessel disease

“…В этой когорте более чем у половины пациентов встречается поражение ствола левой коронарной артерии (СтЛКА), сахарный диабет (СД) и другие факторы, которые создают предпосылки к тому, что для значительной доли пациентов коронарное шунтирование (КШ) может быть оптимальной опцией реваскуляризации [2][3][4]. Большинство исследований показывают, что женский пол и ряд сопутствующих состояний, таких как СД, мультифокальный атеросклероз (МФА) и хроническая почечная недостаточность (ХПН) увеличивают частоту осложнений при ОКС↓ST [5][6][7].…”