Matetic Andrija, Kuchtaruk Adrian, Siudak Zbigniew, Ullah Waqas, Elbadawi Ayman, Elgendy Islam Y, Zaman Sarah, Bang Vijay, Rao Sarita, Bagur Rodrigo, Mamas Mamas A
Department of Cardiology, University Hospital of Split, Split, Croatia; Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
London Health Sciences Centre, Western University, London, Ontario, Canada.
Cardiovasc Revasc Med. 2025 May;74:57-63. doi: 10.1016/j.carrev.2024.07.023. Epub 2024 Jul 27.
This study aimed to investigate the association between index trial participation status and 30-day unplanned readmission rates, causes, and outcomes in acute coronary syndrome (ACS) patients.
The National Readmission Database was analysed for all index hospitalizations with a principal diagnosis of ACS between October 2015 to November 2019, stratified by index trial participation status (International Classification of Diseases - 10th edition code: Z00.6). The 30-day unplanned readmission rates, causes and outcomes were analysed, including the assessment of factors associated with readmission. Multivariable regression analyses were reported as adjusted odds ratios (aOR) with 95 % confidence intervals (95 % CI). All analyses were weighted and utilized hierarchical multi-level organization.
A total of 2,066,328 cases with a principal diagnosis of ACS were included in the study, of which there were 4061 trial participants (0.2 %) and 189,240 (9.2 %) cases experienced unplanned 30-day readmission. Rates of unplanned 30-day readmission were similar between trial participants and non-participants (9.8 % vs. 9.2 %, p = 0.16). Consistently, after multivariable adjustment, there was no significant association between trial participation and unplanned 30-day readmissions (aOR 0.96, 95 % CI 0.86-1.07, p = 0.45). Compared with trial participants, the majority of readmissions in non-participants were related to cardiovascular conditions (55.2 % vs. 46.7 %, p = 0.005, respectively). There was no significant difference in all-cause mortality (5.5 % vs. 4.6 %, p = 0.368, respectively), but trial participants were more likely to develop major bleeding (3.5 % vs. 2.1 %, p = 0.044), ischemic stroke (4.0 % vs. 2.1 %, p = 0.008) and haemorrhagic stroke (2.0 % vs. 0.6 %, p < 0.001) at readmissions.
Overall rates of unplanned 30-day readmissions after ACS are similar between trial participants and non-participants, but non-participation in trials was associated with a higher likelihood of cardiovascular readmission.
本研究旨在调查急性冠状动脉综合征（ACS）患者的索引试验参与状态与30天非计划再入院率、原因及结局之间的关联。
对2015年10月至2019年11月期间主要诊断为ACS的所有索引住院病例进行国家再入院数据库分析，按索引试验参与状态（国际疾病分类第十版编码：Z00.6）分层。分析30天非计划再入院率、原因及结局，包括对与再入院相关因素的评估。多变量回归分析报告为调整后的优势比（aOR）及95%置信区间（95%CI）。所有分析均进行加权并采用分层多级组织。
本研究共纳入2066328例主要诊断为ACS的病例，其中有4061例试验参与者（0.2%），189240例（9.2%）病例经历了30天非计划再入院。试验参与者和非参与者的30天非计划再入院率相似（9.8%对9.2%，p = 0.16）。同样，在多变量调整后，试验参与与30天非计划再入院之间无显著关联（aOR 0.96，95%CI 0.86 - 1.07，p = 0.45）。与试验参与者相比，非参与者的再入院大多与心血管疾病相关（分别为55.2%对46.7%，p = 0.005）。全因死亡率无显著差异（分别为5.5%对4.6%，p = 0.368），但试验参与者在再入院时发生大出血（3.5%对2.1%，p = 0.044）、缺血性卒中（4.0%对2.1%，p = 0.008）和出血性卒中（2.0%对0.6%）的可能性更高（p < 0.001）。
ACS后30天非计划再入院的总体发生率在试验参与者和非参与者之间相似，但未参与试验与心血管再入院的可能性较高相关。
