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Spontaneous Coronary Artery Dissection and 30-Day Hospital Readmission
Study Questions:
What are the 30-day readmission rates following hospitalization with acute myocardial infarction (AMI) due to spontaneous coronary artery dissection (SCAD)?
Methods:
Data from the Nationwide Readmissions Database were used for the present analysis. Hospital admissions for a primary diagnosis of AMI, between January 2010 and August 2015, were identified through International Classification of Diseases (ICD) codes. Patients were grouped by those with and without SCAD. Patients were excluded from the study cohort if they died during the index hospitalization, or their records were missing critical demographic information. Patients were also excluded if they were discharged during the last month of the year’s dataset, as 30-day readmission outcomes would not be feasible. The primary outcome of interest was 30-day readmission rates. Propensity score matching (1:2) was used to compare the two groups.
Results:
A total of 2,654,087 patients with AMI were included in the final analysis, of whom 1,386 (0.052%) were diagnosed with SCAD. The SCAD group was significantly younger compared with the non-SCAD group (48 years [41-53 years] vs. 67 years [56-78 years]; p < 0.001). Most patients in the SCAD group were women (71.0%). Patients with SCAD were generally healthier, and were less likely to have comorbidities or prior cardiovascular conditions. However, during the index hospitalization, patients with SCAD had a higher incidence of several complications, including acute pericarditis, cardiac arrest, cardiogenic shock, hemopericardium, procedural complications, hypotension, shock, ventricular tachycardia, and fibrillation. The unadjusted rates of 30-day readmissions were 12.3% in the SCAD group and 14.9% in the non-SCAD group. SCAD was associated with a higher readmission rate in the SCAD cohort (12.3% vs. 9.9%; p = 0.022). The main causes of readmissions in the SCAD cohort were cardiac causes (80.6%), and AMI was the most common cardiac cause (44.8%), followed by chest pain (20.1%) and arrhythmia (12.7%). Among the SCAD readmissions, 50.6% of patients were readmitted in the first week post-discharge, with 54.5% of AMI readmissions occurring in the first 2 days post-discharge.
Conclusions:
The investigators concluded that the incidence of 30-day readmission following AMI and SCAD is nontrivial and occurs early post-discharge. Most readmissions are due to cardiac causes, especially AMI. Targeted management approaches are needed to diminish the high rates of readmission and early recurrent AMI.
Perspective:
SCAD is an uncommon but significant cause of AMI with potential for adverse events during hospitalization and shortly after discharge. Understanding the long-term sequel of SCAD will likely improve the lives of SCAD patients. Given that these are often younger women with potential long lives ahead of them, reducing the knowledge gap related to SCAD is imperative to improving the quality of life for such patients.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Chest Pain, Coronary Vessel Anomalies, Dissection, Heart Arrest, Hypotension, Myocardial Infarction, Outcome Assessment, Health Care, Patient Discharge, Patient Readmission, Pericardial Effusion, Primary Prevention, Quality of Life, Shock, Cardiogenic, Vascular Diseases
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