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Early vs. Late Readmission following Percutaneous Coronary Intervention: Predictors and Impact on Long-Term Outcomes
David Eccleston1, My-Ngan Duong2, Enayet Chowdhury2
1Department of Medicine, University of Melbourne, Parkville, VIC 3050, Australia.
Insights
Unplanned readmissions after percutaneous coronary intervention (PCI), especially late ones, significantly increase the risk of major adverse cardiac events (MACE) and death within three years. Identifying high-risk patients post-PCI is crucial for better long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Readmissions within one year post-percutaneous coronary intervention (PCI) are common and pose a significant burden.
- Long-term implications of these readmissions are not well understood.
- This study investigates predictors and long-term outcomes of early versus late unplanned readmissions post-PCI.
Purpose of the Study:
- To compare predictors of early (30-day) and late (31-day to 1-year) unplanned readmissions after PCI.
- To assess the impact of unplanned readmission within the first year on long-term clinical outcomes (3-year follow-up).
- To determine which readmission timing (early vs. late) poses a higher risk for adverse long-term outcomes.
Main Methods:
- Analysis of 16,911 patients from the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) (2008-2020).
- Multivariate logistic regression to identify readmission predictors.
- Cox proportional hazards regression to evaluate the impact of readmission on 3-year clinical outcomes (MACE, death).
Main Results:
- 8.5% of patients (1422) experienced unplanned readmission within one year post-PCI.
- Predictors included increasing age, female gender, prior CABG, renal impairment, and PCI for acute coronary syndromes.
- Unplanned readmission within one year increased the risk of MACE (aHR 1.84) and death (aHR 1.86) at 3 years.
- Late readmissions were more strongly associated with subsequent MACE and death between years 1 and 3.
Conclusions:
- Unplanned readmissions within the first year post-PCI, particularly late ones, significantly elevate the risk of MACE and death at 3 years.
- Late readmissions (after 30 days) are associated with a greater risk of adverse long-term outcomes.
- Strategies to identify high-risk patients and implement interventions to reduce readmissions and subsequent adverse events are essential post-PCI.
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.
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