Department of Cardiology, Assaf-Harofeh Medical Center, Israel.
Sackler School of Medicine, Tel-Aviv University, Israel.
Eur Heart J Acute Cardiovasc Care. 2019 Dec;8(8):738-744. doi: 10.1177/2048872618767997. Epub 2018 Apr 4.
Readmissions following acute myocardial infarction are associated with poor outcomes and a heavy economic burden. There are few evidence-based data on the characteristics and outcomes of patients readmitted following acute coronary syndrome. We explored the incidence and outcomes of patients readmitted after an acute coronary syndrome in the past decade.
The study population comprised all acute coronary syndrome patients who were enrolled and prospectively followed up in the biennial Acute Coronary Syndrome Israeli Survey from 2000 to 2013. Multivariate analysis identified factors independently associated with readmission and long-term mortality.
There were 13,010 study patients, of whom 556 (4.2%) had an unplanned readmission within 30 days of the index event. Stent thrombosis during the index hospitalisation (odds ratio (OR) 8.43; 95% confidence interval (CI) 4.11-16.07; <0.001), female sex (OR 1.34; 95% CI 1.1-1.63; =0.003), older age (>65 years; OR 1.28; 95% CI 1.06-1.55; =0.011), and lack of dual-antiplatelet therapy (OR 1.52; 95% CI 1.25-1.86; <0.001) were independently associated with readmission. Readmitted patients were less likely to have been treated with guideline-directed medical therapy during hospitalisation and at discharge, and were less likely to have undergone coronary angiography. A strong trend towards decline in readmission rates following acute coronary syndrome was observed between 2000 and 2013 (<0.001). However, the association between readmission and poor long-term outcome was more pronounced among patients readmitted during more recent years (2008-2013).
Patients readmitted to hospital following acute coronary syndrome comprise an undertreated, high-risk cohort. Our findings indicate that despite a significant decline in readmission rates following acute coronary syndrome over the past decade, readmission within 30 days following acute coronary syndrome still portends a grave outcome.
急性心肌梗死（AMI）后再入院与不良结局和沉重的经济负担相关。有关急性冠状动脉综合征（ACS）后患者再入院特征和结局的循证数据较少。我们探讨了过去十年 ACS 患者再入院的发生率和结局。
研究人群包括 2000 年至 2013 年期间在每两年进行一次的以色列急性冠状动脉综合征调查中纳入并前瞻性随访的所有 ACS 患者。多变量分析确定了与再入院和长期死亡率相关的独立因素。
共纳入 13010 例患者，其中 556 例（4.2%）在指数事件后 30 天内发生非计划性再入院。住院期间支架血栓形成（比值比 [OR] 8.43；95%置信区间 [CI] 4.11-16.07；<0.001）、女性（OR 1.34；95% CI 1.1-1.63；=0.003）、年龄较大（>65 岁；OR 1.28；95% CI 1.06-1.55；=0.011）和未接受双联抗血小板治疗（OR 1.52；95% CI 1.25-1.86；<0.001）与再入院独立相关。再入院患者在住院期间和出院时接受指南指导的药物治疗的可能性较低，且接受冠状动脉造影的可能性较低。2000 年至 2013 年期间，ACS 后再入院率呈明显下降趋势（<0.001）。然而，在最近几年（2008-2013 年）再入院的患者中，再入院与不良长期结局之间的关联更为明显。
ACS 后再入院的患者属于治疗不足、高危人群。我们的研究结果表明，尽管过去十年 ACS 后再入院率显著下降，但 ACS 后 30 天内再入院仍预示着严重的结局。
