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July 20, 2020

Study Evaluates Association of Readmissions After NSTEMI and Index Coronary Revascularizations

July 20, 2020—A study of the rate, causes, and predictors of 90‐day readmissions and the association with index hospitalization coronary revascularization after non–ST-segment elevation myocardial infarction (NSTEMI) in the United States was published by Jayakumar Sreenivasan, MD, et al online ahead of print in Catheterization & Cardiovascular Interventions.

The investigators concluded that readmissions after NSTEMI carry higher mortality than the index hospitalization and that coronary revascularization for NSTEMI is associated with a lower readmission rate at 90 days.

As summarized in Catheterization & Cardiovascular Interventions, the National Readmission Database for 2016 was queried using appropriate International Classification of Diseases, 10th Version, Clinical Modification/Procedure Classification System codes to identify all adult admissions for NSTEMI. The investigators determined 90‐day readmissions for major adverse cardiac events (MACE). All‐cause readmission was a secondary endpoint. The association between coronary revascularization and the likelihood of readmission was analyzed using multivariate Cox regression analysis.

The study included 296,965 adult discharges after an admission for NSTEMI. The rate of readmissions for MACE was 5.2% (n = 15,637) and for any cause was 18% (n = 53,316).

The investigators reported that 38% of MACE readmissions and 40% of all‐cause readmissions occurred between 30 and 90 days after the index hospitalization. During index hospitalization, 51% underwent coronary revascularization (40.8% with percutaneous coronary intervention and 10.2% with coronary artery bypass grafting). This was independently predictive of a lower risk of 90‐day readmission for MACE (adjusted hazard ratio [HR], 0.59; 95% CI, 0.56-0.63; P < .001) and for any cause (adjusted HR, 0.65; 95% CI, 0.63-0.67; P < .001).

In‐hospital mortality for MACE readmissions was significantly higher compared to that of index hospitalization (3.8% vs 2.6%; P < .001), reported the investigators in Catheterization & Cardiovascular Interventions.

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