Percutaneous coronary intervention and 30‐day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database)

Abstract

Percutaneous coronary intervention (PCI) improves anginal chest pain in most, but not all, treated patients. PCI is associated with unplanned readmission for angina and non‐specific chest pain within 30‐days of index PCI. Patients with an index hospitalization for PCI between January–November in each of the years 2010–2014 were included from the United States Nationwide Readmissions Database. Of 2 723 455 included patients, the 30‐day unplanned readmission rate was 7.2% (n = 196 581, 42.3% female). This included 9.8% (n = 19 183) with angina and 11.1% (n = 21 714) with non‐specific chest pain. The unplanned readmission group were younger (62.2 vs 65.1 years; P < 0.001), more likely to be females (41.0% vs 34.2%; P < 0.001), from the lowest quartile of household income (32.9% vs 31.2%; P < 0.001), have higher prevalence of cardiovascular risk factors or have index PCI performed for non‐acute coronary syndromes (ACS) (OR:3.46, 95%CI 3.39–3.54). Factors associated with angina readmissions included female sex (OR:1.28, 95%CI 1.25–1.32), history of ischemic heart disease (IHD) (OR:3.28, 95%CI 2.95–3.66), coronary artery bypass grafts (OR:1.79, 95%CI 1.72–2.86), anaemia (OR:1.16, 95%CI 1.11–1.21), hypertension (OR:1.13, 95%CI 1.09, 1.17), and dyslipidemia (OR:1.10, 95%CI 1.06–1.14). Non‐specific chest pain compared with angina readmissions were younger (mean difference 1.25 years, 95% CI 0.99, 1.50), more likely to be females (RR:1.13, 95%CI 1.10, 1.15) and have undergone PCI for non‐ACS (RR:2.17, 95%CI 2.13, 2.21). Indications for PCI other than ACS have a greater likelihood of readmission with angina or non‐specific chest pain at 30‐days. Readmissions are more common in patients with modifiable risk factors, previous history of IHD and anaemia.

Predictors of Post-Percutaneous Coronary Intervention Chest Pain Among Coronary Heart Disease Patients

“…Kwong et al (2019) suggested that PPCP is likely due to various procedural events, such as abrupt vessel closure, coronary vasospasm, side branch closure, dissection, distal thromboembolism, slow flow, focal vessel stretch, and adventitial injury, which are common with newer devices such as atherectomy and stenting. Nevertheless, PPCP is common even in the absence of procedural events and is commonly attributed to causes related to vasospasm or coronary artery distention (Sykes et al, 2021).…”

A nomogram for predicting the readmission within 6 months after treatment in patients with acute coronary syndrome

“…Although previous studies have found comorbidities and smoking are risk factors for readmission [ 5 ], predictor models for the readmission of ACS were scarce. Besides, current research mainly focused on the prognostic factors of a specific type of ACS [ 6 ], or a single predictor of short-term or long-term prognosis of ACS, such as decreased glomerular filtration rate (GFR) and increased urinary micro-protein/creatinine ratio [ 7 ], the level of mean platelet volume [ 8 ], etc.…”