Risk Score Developed to Predict 30-Day Readmission After PCI

June 2, 2017—Findings on the development and validation of a simple risk score to predict 30-day readmission after percutaneous coronary intervention (PCI) in a cohort of Medicare patients were published by Karl E. Minges, PhD, MPH, et al in Catheterization and Cardiovascular Interventions (CCI; 2017;89:955–966).

The investigators sought to develop a risk model to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge.

As summarized in CCI, the sample included patients aged ≥ 65 years who underwent PCI at a hospital participating in the CathPCI Registry and could be linked with 100% Medicare fee-for-service claims between January 2007 and December 2009. The sample (N = 388,078) was randomly divided into risk score development (n = 193,899) and validation (n = 194,179) cohorts. Staged revascularization procedures were not counted as readmissions. They estimated multivariable logistic regression models using stepwise selection models to identify variables independently associated with all-cause 30-day readmission.

Mean 30-day readmission rates for both cohorts were similar (11.36% for the development cohort vs 11.35% for the validation cohort). In total, 19 variables were significantly associated with risk of 30-day readmission (P < .05), and model C statistics were similar in the development (0.67) and validation (0.66) cohorts. Patients at high and low risk of readmission were identified using the simple risk score based on 14 variables. Patients with a score of ≥ 13 (15.4% of sample) had more than an 18.5% risk of readmission, whereas patients with a score ≤ 6 (41.9% of sample) had less than an 8% risk of readmission.

Using clinical factors present at the time of the procedure, risk of readmission can be estimated in PCI patients. This risk score may guide clinical decision making and resource allocation for PCI patients at the time of hospital discharge, concluded the investigators in CCI.