Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention
Abstract
:1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Not Readmitted (n = 25,423) | Any Cardiac Readmission (n = 1848) | All Non-Cardiac Readmissions (n = 1211) | p | |
---|---|---|---|---|
Baseline characteristics | ||||
Median age, years ± SD | 66.2 ± 11.7 | 66.4 ± 12.0 | 71.1 ± 12.8 | <0.001 |
Female | 5844 (23.0) | 564 (30.5) | 375 (31.0) | <0.001 |
Body mass index groups: | ||||
Underweight | 165 (0.7) | 15 (0.8) | 14 (1.2) | <0.001 |
Normal | 5422 (21.6) | 457 (25.1) | 326 (27.2) | |
Overweight | 10,342 (41.2) | 701 (38.5) | 439 (36.7) | |
Obese | 9144 (36.5) | 649 (35.6) | 418 (34.9) | |
Aboriginal and/or Torres Strait Islander | 104 (0.4) | 10 (0.6) | 7 (0.6) | 0.50 |
Diabetes mellitus | 5427 (21.3) | 425 (23.0) | 315 (26.0) | <0.001 |
Peripheral vascular disease | 833 (3.3) | 80 (4.3) | 60 (5.0) | <0.001 |
Previous cerebrovascular disease | 915 (3.6) | 105 (5.7) | 72 (5.9) | <0.001 |
Previous percutaneous coronary intervention | 5557 (21.9) | 349 (18.9) | 219 (18.1) | <0.001 |
Previous coronary artery bypass graft surgery | 1971 (7.8) | 150 (8.1) | 102 (8.4) | 0.61 |
Stage 4–5 chronic kidney disease (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2) | 445 (1.9) | 54 (3.1) | 63 (5.6) | <0.001 |
Left ventricular ejection fraction (LVEF): | ||||
LVEF ≥50 | 14,744 (67.1) | 1035 (63.3) | 591 (55.6) | <0.001 |
LVEF 45–49 | 4284 (19.5) | 297 (18.2) | 248 (23.4) | |
LVEF 35–44 | 2099 (9.6) | 208 (12.7) | 143 (13.5) | |
LVEF <35 | 843 (3.8) | 94 (5.8) | 80 (7.5) | |
Number of admissions within the previous 12 months: | ||||
0 | 20,196 (79.4) | 1306 (70.7) | 789 (65.2) | <0.001 |
1 | 3749 (14.7) | 311 (16.8) | 238 (19.7) | |
2 | 953 (3.7) | 110 (6.0) | 88 (7.3) | |
3–5 | 480 (1.9) | 90 (4.9) | 81 (6.7) | |
>5 | 45 (0.2) | 31 (1.7) | 15 (1.2) | |
Presentation characteristics: | ||||
Stable angina | 11,499 (45.2) | 470 (25.4) | 396 (32.7) | <0.001 |
Non-ST elevation acute coronary syndrome | 8512 (33.5) | 853 (46.2) | 486 (40.1) | |
ST-elevation myocardial infarction | 5412 (21.3) | 525 (28.4) | 329 (27.2) | |
Cardiogenic shock | 329 (1.3) | 37 (2.0) | 39 (3.2) | <0.001 |
Intubated-out-of-hospital cardiac arrest | 41 (0.2) | 3 (0.2) | 5 (0.4) | 0.12 |
Out-of-hours presentation | 12,226 (48.1) | 952 (51.5) | 607 (50.1) | 0.008 |
Procedural characteristics: | ||||
Radial/brachial access | 13,038 (51.3) | 927 (50.2) | 577 (47.6) | 0.03 |
Femoral access | 12,385 (48.7) | 921 (49.8) | 634 (52.4) | |
Multi-vessel disease | 1689 (6.6) | 117 (6.3) | 84 (6.9) | 0.80 |
ACC/AHA B2/C lesion | 14,252 (56.1) | 1047 (56.7) | 727 (60.0) | 0.02 |
Chronic total occlusion lesion treated | 966 (3.8) | 62 (3.4) | 46 (3.8) | 0.62 |
Unprotected left main vessel lesion | 257 (1.0) | 19 (1.0) | 12 (1.0) | 0.99 |
Drug-eluting stent used | 20,894 (82.2) | 1421 (76.9) | 940 (77.6) | <0.001 |
Glycoprotein IIb/IIIa inhibitor used | 2756 (10.8) | 246 (13.3) | 161 (13.3) | <0.001 |
Unsuccessful percutaneous coronary intervention | 1407 (5.5) | 140 (7.6) | 73 (6.0) | 0.001 |
Not Readmitted (n = 25,423) | Any Cardiac Readmission (n = 1848) | All Non-Cardiac Readmission (n = 1211) | p | |
---|---|---|---|---|
Median length of stay, days [IQR] | 2 (1–4) | 3 (2–5) | 4 (2–6) | <0.001 |
Length of stay <3 days | 13,183 (51.9) | 661 (35.8) | 394 (32.5) | <0.001 |
Length of stay ≥3 | 12,240 (48.1) | 1187 (64.2) | 817 (67.5) | |
Discharge destination: | ||||
Home | 24,382 (95.9) | 1724 (93.3) | 1106 (91.3) | <0.001 |
Hospital in the home | 109 (0.4) | 7 (0.4) | 7 (0.6) | |
Rehab | 445 (1.8) | 40 (2.2) | 54 (4.5) | |
Local or referring hospital | 380 (1.5) | 57 (3.1) | 32 (2.6) | |
Tertiary referral centre | 107 (0.4) | 20 (1.1) | 12 (1.0) | |
In-hospital complications | ||||
New renal impairment | 426 (2.3) | 58 (3.8) | 64 (6.5) | <0.001 |
Cardiogenic shock | 164 (0.6) | 32 (1.7) | 19 (1.6) | <0.001 |
Peri-procedural myocardial infarction | 142 (0.6) | 25 (1.4) | 16 (1.3) | <0.001 |
Unplanned PCI for target vessel revascularisation | 53 (0.2) | 9 (0.5) | 5 (0.4) | 0.03 |
Target lesion revascularisation | 106 (0.4) | 17 (1.0) | 9 (0.8) | 0.003 |
Unplanned coronary artery bypass surgery | 101 (0.4) | 11 (0.6) | 14 (1.2) | <0.001 |
Stent thrombosis | 38 (0.1) | 2 (0.1) | 3 (0.2) | 0.61 |
Major bleeding | 156 (0.6) | 14 (0.8) | 20 (1.7) | <0.001 |
Stroke | 49 (0.2) | 5 (0.3) | 3 (0.2) | 0.72 |
Any of the above in-hospital complications | 621 (2.5) | 90 (5.0) | 69 (5.9) | <0.001 |
Discharge medications | ||||
Aspirin | 24,727 (97.5) | 1791 (97.3) | 1165 (96.4) | 0.09 |
Thienopyridine | 13,802 (54.5) | 900 (49.0) | 625 (51.8) | <0.001 |
Ticagrelor | 11,048 (43.6) | 889 (48.5) | 548 (45.5) | <0.001 |
Beta-blocker | 17,666 (70.1) | 1382 (75.5) | 898 (74.6) | <0.001 |
Angiotensin converting enzyme inhibitors/angiotensin receptor blockers | 18,233 (72.3) | 1325 (72.4) | 880 (73.2) | 0.82 |
Any lipid lowering therapies | 23,791 (94.2) | 1731 (94.2) | 1119 (92.9) | 0.21 |
Oral anticoagulants | 1728 (6.8) | 170 (9.3) | 158 (13.1) | <0.001 |
Any Cardiac Readmission | All Non-Cardiac Readmissions | ||||
---|---|---|---|---|---|
Odds Ratio (95% CI) | p | Odds Ratio (95% CI) | p | ||
Age group | |||||
51–60 years | 1 (ref.) | 1 (ref.) | |||
<40 years | 0.78 (0.53–1.16) | 0.22 | 0.64 (0.34–1.20) | 0.16 | |
41–50 years | 1.18 (0.98–1.42) | 0.08 | 1.03 (0.77–1.39) | 0.83 | |
61–70 years | 0.94 (0.81–1.09) | 0.38 | 1.45 (1.18–1.78) | <0.001 | |
71–80 years | 0.97 (0.83–1.14) | 0.72 | 2.00 (1.63–2.45) | <0.001 | |
>80 years | 1.15 (0.94–1.40) | 0.18 | 2.47 (1.94–3.13) | <0.001 | |
Sex | |||||
Male | 1 (ref.) | 1 (ref.) | |||
Female | 1.46 (1.30–1.64) | <0.001 | 1.29 (1.12–1.49) | <0.001 | |
Diabetes mellitus | 1.08 (0.95–1.23) | 0.25 | 1.21 (1.04–1.40) | 0.02 | |
Peripheral vascular disease | 1.21 (0.92–1.58) | 0.18 | 1.03 (0.76–1.42) | 0.83 | |
Previous stroke | 1.37 (1.08–1.74) | 0.009 | 1.18 (0.89–1.56) | 0.25 | |
Previous PCI | 0.87 (0.75–1.01) | 0.06 | 0.76 (0.63–0.90) | 0.002 | |
Previous CABG | 1.02 (0.82–1.27) | 0.88 | 0.91 (0.71–1.18) | 0.48 | |
Presentation diagnosis | |||||
Stable angina | 1 (ref.) | 1 (ref.) | |||
NSTEACS | 2.62 (2.23–3.09) | <0.001 | 1.71 (1.42–2.06) | <0.001 | |
STEMI | 2.79 (2.29–3.38) | <0.001 | 1.76 (1.40–2.22) | <0.001 | |
Cardiogenic shock at presentation | 1.52 (1.02–2.24) | 0.04 | 1.19 (0.96–1.47) | 0.11 | |
Number of admissions within previous 12 months: | |||||
0 | 1 (ref.) | 1 (ref.) | |||
1 | 1.50 (1.29–1.73) | <0.001 | 1.71 (1.44–2.02) | <0.001 | |
2 | 1.86 (1.47–2.36) | <0.001 | 2.20 (1.69–2.85) | <0.001 | |
3 | 3.36 (2.56–4.40) | <0.001 | 4.58 (3.47–6.06) | <0.001 | |
4 | 11.83 (6.89–20.31) | <0.001 | 8.34 (4.18–16.66) | <0.001 | |
Drug-eluting stent used | 0.88 (0.77–1.01) | 0.08 | 0.87 (0.74–1.03) | 0.11 | |
Unsuccessful PCI | 1.32 (1.05–1.66) | 0.02 | 1.05 (0.86–1.29) | 0.62 | |
Any in-hospital complication | 1.72 (1.32–2.23) | <0.001 | 1.71 (1.26–2.31) | 0.001 | |
Left ventricular ejection fraction (LVEF): | |||||
LVEF 50% | 1 (ref.) | 1 (ref.) | |||
LVEF 45–49% | 1.22 (1.04–1.45) | 0.02 | 1.07 (0.90–1.27) | 0.44 | |
LVEF 35–44% | 1.33 (1.09 1.64) | 0.006 | 1.14 (0.89–1.45) | 0.30 | |
LVEF <35% | 1.39 (1.06–1.82) | 0.02 | 1.19 (0.96–1.47) | 0.11 | |
Discharged on oral anticoagulant | 1.26 (1.05–1.53) | 0.02 | 1.50 (1.22–1.84) | <0.001 |
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Share and Cite
Biswas, S.; Dinh, D.; Lucas, M.; Duffy, S.J.; Brennan, A.L.; Liew, D.; Cox, N.; Nadurata, V.; Reid, C.M.; Lefkovits, J.; et al. Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention. J. Clin. Med. 2020, 9, 3242. https://doi.org/10.3390/jcm9103242
Biswas S, Dinh D, Lucas M, Duffy SJ, Brennan AL, Liew D, Cox N, Nadurata V, Reid CM, Lefkovits J, et al. Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention. Journal of Clinical Medicine. 2020; 9(10):3242. https://doi.org/10.3390/jcm9103242
Chicago/Turabian StyleBiswas, Sinjini, Diem Dinh, Mark Lucas, Stephen J. Duffy, Angela L. Brennan, Danny Liew, Nicholas Cox, Voltaire Nadurata, Christopher M. Reid, Jeffrey Lefkovits, and et al. 2020. "Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention" Journal of Clinical Medicine 9, no. 10: 3242. https://doi.org/10.3390/jcm9103242