Department of Internal Medicine, Mount Sinai St Luke's-West Hospital, New York, New York.
Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2019 Dec 15;124(12):1841-1850. doi: 10.1016/j.amjcard.2019.08.048. Epub 2019 Sep 26.
Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is paucity of data on readmissions in this study population. We aimed to assess the burden, major etiologies, and resource utilization for 30-day readmissions among patients with STEMI and CS. The Nationwide Readmission Database was queried from 2010 to 2014. All adult patients with an index admission for STEMI-CS were identified using International Classification of Diseases, ninth edition codes. Patient with mortality on index admission and transfers to other hospitals were excluded. A total of 18,659 admissions were identified with primary diagnosis of STEMI-CS for the study duration. Percutaneous coronary interventions was performed in 78.1% and mechanical circulatory devices were utilized in 53.9% with a mean length of stay of 10.6 (±0.2) days and mean cost of hospitalization of $47,744 (±327). Among these, 2,404 (12.9%) patients were readmitted within 30 days. Major etiologies for readmission include congestive heart failure (25.7%), acute myocardial infarction (9.4%), arrhythmias (4.5%), and sepsis (4.2%). The mean length of stay and cost of hospitalization for 30-day readmission were 5.9 (±0.3) days and $17,043 (±590), respectively. Older age, female gender, lower socioeconomic status, and discharge to home health care were significant predictors for readmission. In conclusion, there is a significant burden of 30-day readmission among patients with STEMI-CS. Percutaneous coronary interventions and mechanical circulatory devices were utilized in a majority of index admissions. Congestive heart failure was the single most common reason for 30-day readmission. Patients discharged to skilled nursing facility, patients with private insurance and higher socioeconomic status were less likely to be readmitted. Moreover, readmissions among STEMI-CS patients contribute to significant resource utilization.
ST 段抬高型心肌梗死合并心源性休克(STEMI-CS)的管理在过去十年中得到了发展。在这项研究人群中,关于再入院的数据很少。我们旨在评估 STEMI 和 CS 患者 30 天再入院的负担、主要病因和资源利用情况。从 2010 年到 2014 年,我们从全国再入院数据库中查询了数据。使用国际疾病分类,第九版代码,确定了索引入院时患有 STEMI-CS 的所有成年患者。排除索引入院时死亡和转院的患者。在研究期间,共确定了 18659 例符合 STEMI-CS 主要诊断的入院病例。78.1%的患者接受了经皮冠状动脉介入治疗,53.9%的患者使用了机械循环装置,平均住院时间为 10.6(±0.2)天,平均住院费用为 47744 美元(±327)。其中,2404(12.9%)名患者在 30 天内再次入院。再入院的主要病因包括充血性心力衰竭(25.7%)、急性心肌梗死(9.4%)、心律失常(4.5%)和败血症(4.2%)。30 天再入院的平均住院时间和住院费用分别为 5.9(±0.3)天和 17043 美元(±590)。年龄较大、女性、较低的社会经济地位以及出院至家庭保健是再入院的显著预测因素。总之,STEMI-CS 患者 30 天再入院的负担很大。索引入院时,大多数患者接受了经皮冠状动脉介入治疗和机械循环装置。充血性心力衰竭是 30 天再入院的单一最常见原因。出院到熟练护理机构、有私人保险和较高社会经济地位的患者不太可能再入院。此外,STEMI-CS 患者的再入院导致了大量资源的利用。