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Coronary artery disease
Original research
Association between age and readmission after percutaneous coronary intervention for acute myocardial infarction
  1. Yingyi Qin1,
  2. Xin Wei2,
  3. Hedong Han1,
  4. Yumeng Wen3,
  5. Kevin Gu4,
  6. Yiming Ruan1,
  7. Claire Huang Lucas5,
  8. Usman Baber6,
  9. Matthew I Tomey6,
  10. Jia He1,7
  1. 1 Department of Health Statistics, Second Military Medical University, Shanghai, China
  2. 2 Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3 Division of Nephrology, Johns Hopkins University school of medicine, Baltimore, Maryland, USA
  4. 4 Division of Cardiology, Department of Medicine, Mcmaster University Hospital, Hamilton, Ontario, Canada
  5. 5 Department of medicine, Mount Sinai St. Luke’s and West Medical Center, New York, New York, USA
  6. 6 Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
  7. 7 Tongji University School of Medicine, Shanghai, China
  1. Correspondence to Professor Jia He, Tongji University School of Medicine, Shanghai 200092, China; hejia63{at}yeah.net; Dr Matthew I Tomey; matthew.tomey{at}mountsinai.org

Abstract

Objective This study aimed to investigate the association between age and the risk of 30-day unplanned readmission among adult patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Methods This retrospective analysis included patients from the Nationwide Readmissions Database with AMI who underwent PCI during 2013–2014. We used multivariable logistic regression model to calculate adjusted odds ratios (AORs) for risk of readmission. To examine potential non-linear association, we performed logistic regression with restricted cubic splines (RCS).

Results Of the 492 550 patients with AMI aged above 18 years undergoing PCI during the index hospitalisation, 48 630 (9.87%) were readmitted within 30 days. Although the crude readmission rate of younger patients (aged 18–54 years) was the lowest (7.27%), younger patients had higher risk of readmission compared with patients aged 55–64 years for all-causes (AOR 1.06 (1.01 to 1.11), p=0.0129) and specific causes, such as AMI and chest pain (both cardiac and non-specific) after adjusted for covariates. Patients aged 65–74 years were at lower risk of all-cause readmission. Older patients (age ≥75 years) had higher risk of readmission for heart failure (AOR 1.50 (1.29 to 1.74)) and infection (AOR 1.44 (1.16 to 1.79)), but lower risk for chest pain. RCS analyses showed a U-shaped relationship between age and readmission risk.

Conclusions Our results suggest higher risk of readmission in younger patients for all-cause unplanned readmission after adjusted for covariates. The trends of readmission risk along with age were different for specific causes. Age-targeted initiatives are warranted to reduce preventable readmissions in patients with AMI undergoing PCI.

  • acute myocardial infarction
  • percutaneous coronary intervention
  • readmission
  • restricted cubic splines

https://doi.org/10.1136/heartjnl-2019-316103

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    Footnotes

    • YQ, XW, HH and YW contributed equally.

    • Contributors Study concept and design: YQ, XW, HH, YW, JH. Acquisition of data: YR. Analysis and interpretation of data: YQ, XW, HH, YW, JH. Statistical analysis: YQ, HH. Drafting of the manuscript: YQ, XW, YW, MIT. Revision of the manuscript: KG, CHL, YQ, XW, HH, YW, UB.

    • Funding This study was conducted under a grant from the Fourth Round of Shanghai Three-year Action Plan on Public Health Discipline and Talent Program: Evidence-based Public Health and Health Economics (No. 15GWZK0901), Shanghai Sailing Program (No. 18YF1429500), National Thirteenth Five Year Plan Major Special Project (2017ZX09304016) and National Science and Technology Major Project (Grant No. 2017ZX09304030).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design or conduct or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. The National Readmission Database (NRD) is part of a family of databases and software developed by the Healthcare Cost and Utilization Project (HCUP).