Department of Health Statistics, Second Military Medical University, Shanghai, China.
Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA.
Heart. 2020 Oct;106(20):1595-1603. doi: 10.1136/heartjnl-2019-316103. Epub 2020 Mar 6.
This study aimed to investigate the association between age and the risk of 30-day unplanned readmission among adult patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).
This retrospective analysis included patients from the Nationwide Readmissions Database with AMI who underwent PCI during 2013-2014. We used multivariable logistic regression model to calculate adjusted odds ratios (AORs) for risk of readmission. To examine potential non-linear association, we performed logistic regression with restricted cubic splines (RCS).
Of the 492 550 patients with AMI aged above 18 years undergoing PCI during the index hospitalisation, 48 630 (9.87%) were readmitted within 30 days. Although the crude readmission rate of younger patients (aged 18-54 years) was the lowest (7.27%), younger patients had higher risk of readmission compared with patients aged 55-64 years for all-causes (AOR 1.06 (1.01 to 1.11), p=0.0129) and specific causes, such as AMI and chest pain (both cardiac and non-specific) after adjusted for covariates. Patients aged 65-74 years were at lower risk of all-cause readmission. Older patients (age ≥75 years) had higher risk of readmission for heart failure (AOR 1.50 (1.29 to 1.74)) and infection (AOR 1.44 (1.16 to 1.79)), but lower risk for chest pain. RCS analyses showed a U-shaped relationship between age and readmission risk.
Our results suggest higher risk of readmission in younger patients for all-cause unplanned readmission after adjusted for covariates. The trends of readmission risk along with age were different for specific causes. Age-targeted initiatives are warranted to reduce preventable readmissions in patients with AMI undergoing PCI.
本研究旨在探讨经皮冠状动脉介入治疗（PCI）的成年急性心肌梗死（AMI）患者年龄与 30 天非计划性再入院风险之间的关系。
本回顾性分析纳入了 2013-2014 年期间在全国再入院数据库中接受 PCI 的 AMI 患者。我们使用多变量逻辑回归模型计算调整后的比值比（AOR），以评估再入院风险。为了检验潜在的非线性关联，我们使用受限立方样条（RCS）进行逻辑回归。
在索引住院期间接受 PCI 的 492550 名年龄在 18 岁以上的 AMI 患者中，48630 名（9.87%）在 30 天内再次入院。尽管年轻患者（18-54 岁）的粗再入院率最低（7.27%），但与 55-64 岁的患者相比，所有原因（AOR 1.06（1.01 至 1.11），p=0.0129）和特定原因（如 AMI 和胸痛[心脏和非特异性]）的再入院风险更高，这些原因在调整了协变量后。65-74 岁的患者发生所有原因再入院的风险较低。年龄较大的患者（年龄≥75 岁）因心力衰竭（AOR 1.50（1.29 至 1.74））和感染（AOR 1.44（1.16 至 1.79））的再入院风险更高，但因胸痛的再入院风险更低。RCS 分析显示年龄与再入院风险之间存在 U 形关系。
在调整了协变量后，我们的结果表明，年轻患者发生所有原因非计划性再入院的风险更高。不同特定原因的再入院风险与年龄的趋势不同。需要针对年龄的干预措施来降低接受 PCI 的 AMI 患者的可预防再入院率。
