Readmission Rates After Inpatient PCI Evaluated From 2000–2012

July 25, 2016—Between 2000 and 2012, readmission rates after percutaneous coronary intervention (PCI) declined, despite patients having more comorbidities, concluded Christian McNeely, MD, et al in a study published online ahead of print in the American Heart Journal (AHJ). The investigators found that there was a 33% lower likelihood of readmission in 2012 compared to 2000, with a small proportion of readmissions for acute coronary syndromes. 

The background of the study is that reducing hospital readmissions has become a public health priority since the year 2000. Additionally, during this period, there have been major changes in PCI.

As summarized in AHJ, the cohort consisted of 3,250,194 patients admitted for PCI from January 2000 through November 2012. Overall, the 30-day readmission rate was 15.8%. Readmission rates declined from 16.1% in 2000 to 15.4% in 2012 (the adjusted odds ratio for readmission was 1.33 in 2000 compared to 2012). Of all readmissions after PCI, the majority were for cardiovascular-related conditions (> 60%); however, only a small percentage (< 8%) of total readmissions were for acute myocardial infarction, unstable angina, or cardiac arrest/cardiogenic shock. 

A much larger percentage of patients were readmitted with chest pain/angina (7.9%), chronic ischemic heart disease (26.6%), and heart failure (12%). A small proportion was due to procedural complications and gastrointestinal bleeding. 

The use of PCI with stenting during readmissions was variable, increasing from 14.2% in 2000 to 23.7% in 2006, and then declining to 12.1% in 2012. Hospital mortality during readmission was 2.5% overall and varied over time (2.8% in 2000, decreasing to 2.2% in 2006, and then rising again to 3.1% in 2012). Patients who were readmitted had more than four times higher 30-day mortality than those who were not, reported the investigators in AHJ.