Kwok Chun Shing, Rao Sunil V, Gilchrist Ian, Martinez Sara C, Al Ayoubi Fakhr, Potts Jessica, Rashid Muhammad, Kontopantelis Evangelos, Myint Phyo K, Mamas Mamas A
Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Department of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
Am J Cardiol. 2018 Jul 15;122(2):220-228. doi: 10.1016/j.amjcard.2018.03.367. Epub 2018 Apr 12.
It is unclear how age affects rates and causes of unplanned early readmissions after percutaneous coronary intervention (PCI). We analyzed patients in the Nationwide Readmission Database in the United States from 2010 to 2014 and examined the impact of age on readmissions after PCI. The primary outcomes were age-specific 30-day rates and causes of unplanned readmissions. A total of 2,294,345 procedures were analyzed with a 9.6% unplanned readmission rate within 30 days. Unplanned readmissions were 8.1%, 8.1%, 9.5%, and 12.6% for age groups <55, 55.0 to 64.9, 65.0-74.9, and ≥75 years, respectively. With increasing age, there was an increase in the rate of noncardiac causes for readmissions (for ages <55, 55.0 to 64.9, and ≥75 years, the rates were 54.1%, 54.8%, 56.6%, and 57.1%, respectively; p <0.001). Older age was associated with an increased prevalence of infections (13.9% ≥75 years vs 7.7% <55 years), gastrointestinal disease (11.5% ≥75 years vs 9.5% <55 years), and bleeding (7.4% ≥75 years vs 2.9% <55 years) as causes for noncardiac readmissions and a reduced prevalence of nonspecific chest pain (9.9% ≥75 years vs 31.4% <55 years). For cardiac causes, older age was associated with increased prevalence for readmissions due to heart failure (34.6% ≥75 years vs 11.9% <55 years) but a reduced prevalence of coronary artery disease, including angina (25.7% ≥75 years vs 51.3% <55 years). In conclusion, older patients have the highest rates of unplanned 30-day readmissions after PCI, with different causes for readmission compared with younger patients. Interventions designed to reduce readmissions after PCI should be age specific.
目前尚不清楚年龄如何影响经皮冠状动脉介入治疗（PCI）后计划外早期再入院率及原因。我们分析了2010年至2014年美国全国再入院数据库中的患者，并研究了年龄对PCI后再入院的影响。主要结局是特定年龄的30天计划外再入院率及原因。共分析了2,294,345例手术，30天内计划外再入院率为9.6%。年龄＜55岁、55.0至64.9岁、65.0 - 74.9岁和≥75岁年龄组的计划外再入院率分别为8.1%、8.1%、9.5%和12.6%。随着年龄增长，非心脏原因导致的再入院率增加（年龄＜55岁、55.0至64.9岁和≥75岁的比率分别为54.1%、54.8%、56.6%和57.1%；p＜0.001）。年龄较大与感染（≥75岁为13.9%，＜55岁为7.7%）、胃肠道疾病（≥75岁为11.5%，＜55岁为9.5%）和出血（≥75岁为7.4%，＜55岁为2.9%）作为非心脏再入院原因的患病率增加以及非特异性胸痛患病率降低（≥75岁为9.9%，＜55岁为31.4%）相关。对于心脏原因，年龄较大与因心力衰竭导致的再入院患病率增加（≥75岁为34.6%，＜55岁为11.9%）相关，但冠状动脉疾病（包括心绞痛）的患病率降低（≥75岁为25.7%，＜55岁为51.3%）。总之，老年患者PCI后30天计划外再入院率最高，与年轻患者相比，再入院原因不同。旨在降低PCI后再入院率的干预措施应针对不同年龄。
