Abstract
IntroductionReadmission following a percutaneous coronary intervention (PCI) procedure is undesirable, being associated with patient morbidity and financial penalties. US data suggest 30 day readmission rates of approximately 10%, however little data is available within the UK. Reductions in the length of stay following PCI potentially increase the likelihood of early readmission. This study reviewed readmission’s following PCI undertaken in a non-surgical PCI centre in the UK.MethodsHospital admission databases were reviewed for all patients who had undergone a PCI at the centre. All patients who were readmitted to the Trust within 30 days of their PCI were identified, and a retrospective analysis was then undertaken of their hospital records.ResultsThe data set comprised of 3754 patients who had all undergone at least one PCI procedure over the past 6 years. Of these, 409 patients (10.9%) were readmitted within 30 days. A significantly greater proportion of readmission’s within 30 days had an index PCI for acute coronary syndrome (ACS, 63.8% vs. 49.6%, p<0.01). Index PCI procedural success was high and comparable between the group of patients who were readmitted and those who were not.Abstract 25 Figure 1The average duration of time between the index PCI and readmission was 11.6 days, with a trend towards earlier presentation in those patients representing with a cardiac diagnosis (10.8 days vs. 12.2 days, p=0.09). Non-cardiac diagnoses were the greatest contributing diagnosis for all readmission’s, with non-cardiac chest pain, gastrointestinal reflux disease and bony injuries (as others) the commonest final diagnosis.Cardiac readmission’s accounted for 41.4% of all cases with angina and ACS the final diagnosis in 65.4% of patients. 61 patients (14.4%) had a repeat angiogram, with 31 leading to no change in treatment. 18 patients underwent an admission which led to a non-target vessel revascularisation, and 12 patients a target vessel revascularisation. The commonest treatments were no change in medication (41.4%), changes to non-cardiac medication (11.4%) and changes to anti-anginal medication (11.2%). Cardiac readmission’s had a greater rate of mortality at twelve months (2.9% vs. 0.8%, p=0.29).Abstract 25 Table 1VariableTotal populationReadmitted< 30 daysNo readmissionP value Age, mean (SD)64.4 (11.7)65.2 (12.6)64.3 (11.6)0.15Male, n (%)2604/3754 (69.4)272/409 (66.5)2332/3345 (69.7)0.18Hyperlipidaemia (%)2247/3529 (63.7)275/409 (67.2)1972/3120 (63.2)0.11Hypertension (%)1977/3529 (56.0)250/409 (61.1)1727/3120 (55.4)0.03Diabetes (%)849/3520 (24.1)101/409 (24.7)748/3120 (24.0)0.75Drug eluting stent use2840/3735 (76.0)320/409 (78.2)2520/3326 (75.8)0.27Radial access3437/3754 (91.6)383/409 (93.6)3054/3345 (91.3)0.70Procedural success3549/3754 (94.5)388/409 (94.9)3161/3345 (94.5)0.55Same day discharge1157/3500 (33.1)70/387 (17.1)1087/3113 (34.9)<0.01Abstract 25 Table 2VariableTotal populationCardiacNon-cardiacp value Days between PCI and readmission average in days (SD days)11.6 (8.1)10.8 (8.1)12.2 (8.1)0.09Length of stay average in days (SD days)5.3 (12.4)4.0 (6.7)6.4 (15.9)0.08Angiogram (%)61 (14.4)54 (31.8)7 (2.9)<0.01Echocardiogram (%)28 (6.6)20 (11.8)8 (3.3)<0.01Cardiologist review (%)167 (39.3)127 (74.7)40 (16.6)<0.01Cardiac diagnosis (%)170 (41.4)Discharged home (%)392 (92.2)159 (93.5)233 (96.7)0.27Died at twelve months (%)7 (1.7)5 (2.9)2 (0.8)0.29ConclusionCardiac readmission’s continue to occur after 10% of percutaneous coronary intervention procedures. Whilst the prognosis is good, measures to reduce these rates are required.Abstract 25 Figure 2