Hospital Readmission Occurs Frequently For Patients With Certain Type of Heart Attack Who Receive PCI



Patients with a ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) who received a primary percutaneous coronary intervention (PCI) had a hospital readmission rate of 7 to 20 percent after 3 years for new coronary revascularization procedures, heart failure, heart attack, and serious bleeding events, which were negatively associated with long-term survival for these patients, according to results of a research letter published in the November 28 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

“The implementation of primary percutaneous coronary intervention has significantly improved the clinical outcome of patients admitted for STEMI. However, some patients still develop recurrent adverse events, with a negative impact on survival,” according to background information in the article.

Gianluca Campo, M.D., of the Azienda Ospedaliera Universitaria Sant’Anna and Laboratorio di Terapie e Tecnologie Avanzate, Ferrara, Italy, and colleagues analyzed data from the REAL (Regisiro Angioplastiche dell’Emilia-Romagna) registry in order to evaluate the 3-year readmission rate for cardiovascular causes and their influence on death. The study population included 11,118 patients with STEMI (from January 2003 to June 2009) undergoing primary PCI enrolled in the REAL registry. After the index hospitalization, the researchers observed 7,867 readmissions.

“The most frequent diseases or conditions associated with hospital readmissions were coronary revascularization (CR; 28 percent), acute or congestive heart failure (HF; 26 percent), supraventricular arrhythmias (SA; 13 percent), MI (11 percent), and serious bleeding events (SBE; 10 percent). Interestingly, the patients with one hospital admission for HF, SA, or SBE frequently showed a second (or more) readmission for the same cause (36 percent, 34 percent, and 22 percent, respectively). All these events tended to be more frequent during the first year. This was particularly evident for CR. Approximately 60 percent of these procedures was target vessel revascularization, whereas approximately 17 percent was staged intervention,” the authors write.

Overall, there were 1,779 deaths. The cumulative incidence of death was 12.1 percent at one year and 17.5 percent at three years. Mortality was associated with the occurrence of adverse events requiring a new hospitalization.

“Several registries suggest that there is an underuse of effective cardiac therapies. Our findings reinforce the need for the application of timely and effective preventive and treatment strategies,” the researchers write.

(Arch Intern Med. 2011;171[21]:1948-1949.