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Readmissions in ST-Elevation Myocardial Infarction and Cardiogenic Shock (from Nationwide Readmission Database) - 23/11/19

Doi : 10.1016/j.amjcard.2019.08.048 
Karan Sud, MD a, Faris Haddadin, MD a, Rayji S. Tsutsui, MBChB b, Akhil Parashar, MD c, Dhrubajyoti Bandyopadhyay, MD a, Stephen G. Ellis, MD b, E. Murat Tuzcu, MD b, Samir Kapadia, MD b,
a Department of Internal Medicine, Mount Sinai St Luke's-West Hospital, New York, New York 
b Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 
c Department of Cardiology, University of Iowa Hospitals and Iowa City VA Medical Center, Iowa City, Iowa 

Corresponding author: Tel: 216 444 6735.

Riassunto

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.

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Vol 124 - N° 12

P. 1841-1850 - dicembre 2019 Ritorno al numero
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