McNeely Christian, Markwell Stephen, Vassileva Christina M
Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, IL.
Southern Illinois University School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Springfield, IL.
Am Heart J. 2016 Sep;179:195-203. doi: 10.1016/j.ahj.2016.07.002. Epub 2016 Jul 14.
Since year 2000, reducing hospital readmissions has become a public health priority. In addition, there have been major changes in percutaneous coronary intervention (PCI) during this period.
The cohort consisted of 3,250,194 patients admitted for PCI from January 2000 through November 2012.
Overall, 30-day readmission was 15.8%. Readmission rates declined from 16.1% in 2000 to 15.4% in 2012 (adjusted odds ratio for readmission 1.33 in 2000 compared with 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 (GI) 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 >4× higher 30-day mortality than those who were not.
Among Medicare beneficiaries, readmission after PCI declined over time despite patients having more comorbidities. This translated into a 33% lower likelihood of readmission in 2012 compared with 2000. A small proportion of readmissions were for acute coronary syndromes.
自2000年以来，降低医院再入院率已成为公共卫生的重点。此外，在此期间经皮冠状动脉介入治疗（PCI）也发生了重大变化。
该队列包括2000年1月至2012年11月因PCI入院的3250194例患者。
总体而言，30天再入院率为15.8%。再入院率从2000年的16.1%下降至2012年的15.4%（2000年与2012年相比，再入院的调整比值比为1.33）。在PCI后的所有再入院病例中，大多数是心血管相关疾病（>60%）；然而，急性心肌梗死、不稳定型心绞痛或心脏骤停/心源性休克导致的再入院病例仅占总再入院病例的一小部分（<8%）。因胸痛/心绞痛（7.9%）、慢性缺血性心脏病（26.6%）和心力衰竭（12%）再次入院的患者比例要大得多。一小部分是由于手术并发症和胃肠道出血。再入院期间使用带支架的PCI情况各不相同，从2000年的14.2%增加到2006年的23.7%，然后在2012年降至12.1%。再入院期间的医院死亡率总体为2.5%，且随时间变化（2000年为2.8%，2006年降至2.2%，然后在2012年再次升至3.1%）。再入院患者的30天死亡率比未再入院患者高4倍以上。
在医疗保险受益人中，尽管患者合并症增多，但PCI后的再入院率随时间下降。与2000年相比，2012年再入院的可能性降低了33%。一小部分再入院是由于急性冠状动脉综合征。
