Abstract 17169: Chest Pain Readmission After Percutaneous Coronary Intervention is Common but Not Associated With a Worse Prognosis
Background: Readmission rates are currently discussed as a quality outcome. Chest pain readmission after percutaneous coronary intervention (PCI) is challenging and a concern for clinicians. Furthermore, its prognostic implications are poorly understood. The study aims to determine the prognosis of patients discharged after PCI, readmitted for chest pain in the long-term follow-up.
METHODS: Patients undergoing PCI at our hospital are prospectively followed for at least 12 months. From a total of 746 patients discharged after PCI for any reason between 2007 and 2011, 389 patients were readmitted for any cause (mean age 66.4±11; 84.5% male) after a mean follow-up of 27±0.5 months. We studied baseline clinical characteristics, procedure details and laboratory parameters. During the follow-up we analyzed first readmission incidence, cause of readmission and all-cause mortality. Survival was assessed by Kaplan Meier curves and Log-Rank test for group comparison, and a Cox proportional-hazards model was built for HR adjustment.
RESULTS: Out of 746 patients, 389 were readmitted (52%), 222 (29.8%) for cardiovascular causes and 181 (24.3%) due to chest pain. Mean time to readmission was 12.8±0.61 months after discharge. Survival in readmitted patients was lower during the follow-up (mean survival 50.7 vs. 53.2 months respectively, p<0.001). Prognosis in patients readmitted for chest pain was better compared to other causes of readmission (mean survival of 52.2 months versus 47.9 months respectively, p<0.001).
Chest pain readmitted patients had similar prognosis compared to those without readmission (mean survival 52.3 months vs. 53.22, p=0.48). This may be explained because chest-pain patients were younger, had better LVEF and less prevalence of diabetes and chronic kidney disease. Compared to readmission for other causes, chest pain readmission was associated with lower mortality in the multivariable model adjusted for baseline clinical variables (HR 0.328; 95%CI 0.15 - 0.720).
CONCLUSION: Long-term all-cause readmission after PCI is associated with a worse prognosis. Readmission for chest pain was frequent but not associated with a worse prognosis compared to readmission for other causes; with similar survival than non-readmitted patients.
- © 2013 by American Heart Association, Inc.