Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai St Luke's-Mount Sinai West Hospital, New York, New York.
Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Catheter Cardiovasc Interv. 2019 Feb 15;93(3):373-379. doi: 10.1002/ccd.27838. Epub 2018 Oct 2.
Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact.
Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS.
The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code.
We identified a total of 300,269 patients admitted with NSTE-ACS; 13.4% were readmitted within 30-day. The most common cause of readmission was heart failure (HF) (15.6%), followed by a recurrent myocardial infarction (MI) (10%). Predictors of increased readmissions were age ≥ 75 years (OR: 1.34, 95% CI: 1.30-1.39), female gender (OR 1.12, 95% CI 1.09-1.16), a Charlson Comorbidity Index (CCI) >3 (OR 2.11, 95% CI: 2.04-2.18), ESRD (OR 2.01, 95% CI 1.89-2.14), CKD (OR: 1.58, 95% CI: 1.51-1.64), length of stay ≥5 days (OR: 1.51, 95% CI 1.46-1.56) and adverse events during the index admission such as AKI (OR:1.31, 95% CI: 1.25-1.36), major bleeding (OR:1.20, 95% CI: 1.12-1.24); whereas admission to a teaching hospital (OR 0.92, 95% CI 0.89-0.95) and PCI (OR 0.70, 95% CI 0.67-0.72) were associated with less likelihood of 30-day readmission.
Readmission rate at 30-days is high among NSTE-ACS patients and the most common readmission etiologies are HF and recurrent MI. A CCI more than 3 and ESRD were the most significant predictors for readmission; patients undergoing PCI had less odds of readmission.
尽管非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）住院患者的急性治疗和存活率有所提高，但早期再入院仍然很常见，并且具有显著的临床和经济影响。
确定 NSTE-ACS 患者 30 天再入院的预测因素和病因。
本研究队列来自于 2014 年国家再入院数据库，使用 ICD9 代码确定有 NSTE-ACS 主要诊断的患者。
我们共确定了 300269 例因 NSTE-ACS 入院的患者；其中 13.4%在 30 天内再次入院。再入院的最常见原因是心力衰竭（HF）（15.6%），其次是复发性心肌梗死（MI）（10%）。再入院风险增加的预测因素包括年龄≥75 岁（OR：1.34，95%CI：1.30-1.39）、女性（OR 1.12，95%CI 1.09-1.16）、Charlson 合并症指数（CCI）>3（OR 2.11，95%CI：2.04-2.18）、终末期肾病（OR 2.01，95%CI 1.89-2.14）、慢性肾脏病（OR：1.58，95%CI：1.51-1.64）、住院时间≥5 天（OR：1.51，95%CI：1.46-1.56）和指数住院期间的不良事件，如急性肾损伤（AKI）（OR：1.31，95%CI：1.25-1.36）、大出血（OR：1.20，95%CI：1.12-1.24）；而入住教学医院（OR 0.92，95%CI 0.89-0.95）和经皮冠状动脉介入治疗（PCI）（OR 0.70，95%CI 0.67-0.72）与 30 天内再入院的可能性降低相关。
NSTE-ACS 患者的 30 天再入院率较高，最常见的再入院病因是心力衰竭和复发性心肌梗死。CCI>3 和 ESRD 是再入院的最重要预测因素；接受 PCI 的患者再入院的可能性较低。
