Abstract 345: High Risk Characteristics of Patients Returning Within 30 Days After PCI with Chest Discomfort
Background: To improve care coordination, Medicare is reporting 30-day readmissions after percutaneous coronary interventions (PCI) as a quality metric. Chest pain or other symptoms concerning for angina is the most common reason for early hospital readmission after PCI. To reduce hospital readmission in ways that improve value and ensure patient safety, clinicians need to understand which patients returning with symptoms are at high risk and merit admission.
Methods: The Partners PCI Readmission Database is a database of 893 patients readmitted within 30 days of PCI that includes detailed information from chart review. Among patients readmitted for chest pain, or other symptoms concerning for angina, we evaluated patient characteristics associated with either myocardial infarction or repeat PCI during the readmission. Continuous variables were evaluated with t-tests and categorical variables with chi-squared tests. Variables with p < 0.3 on initial screen were included to create a logistic regression model, and a C-statistic was calculated.
Results: Of these patients, 341 (38.1%) were readmitted for evaluation of chest pain or other symptoms concerning for angina, of which 65 (19.1%) required PCI or met criteria for myocardial infarction during the readmission (PCI/MI patients). Age, Caucasian race, hypertension, prior PCI (before the PCI during the index admission), diabetes, multivessel disease found on index catheterization, and drug-eluting stent found on index catheterization all were found to have p < 0.3 in bivariate comparisons and included in the model (Figure 1). The C-statistic of the model was 0.71.
Conclusions: Among patients returning with chest pain or other anginal symptoms within 30 days after PCI, this model can be used to predict likelihood of having a myocardial infarction or requiring repeat PCI. The association of race with PCI/MI merits further investigation. This model may help physicians risk-stratify patients for readmission versus outpatient evaluation.
Author Disclosures: J.H. Wasfy: None. J.B. Strom: None. L. Mauri: B. Research Grant; Significant; Abbott, Boston Scientific, Cordis, Medtronic, Eli Lilly, Daiichi Sankyo, Bristol Myers Squibb, Sanofi-Aventis. G. Consultant/Advisory Board; Modest; Cordis. G. Consultant/Advisory Board; Significant; Medtronic. S.T. Normand: None. K.F. Kennedy: None. J.A. Spertus: B. Research Grant; Significant; American College of Cardiology Foundation. F. Ownership Interest; Modest; Health Outcomes Sciences. R.W. Yeh: None.
This research has received full or partial funding support from the American Heart Association, Founders Affiliate (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont).
- © 2014 by American Heart Association, Inc.