Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction

Suzanne V. Arnold, Kim G. Smolderen, Kevin F. Kennedy, Yan Li, Supriya Shore, Joshua M. Stolker, Tracy Y. Wang, Philip G. Jones, Zhenxiang Zhao, John A. Spertus

Research output: Contribution to journalArticleScientificpeer-review

43 Downloads (Pure)

Abstract

Background
Rehospitalizations for acute coronary syndromes (ACS) and coronary revascularization after an acute myocardial infarction (AMI) are not only common and costly but can also impact patients’ quality of life. In contrast to mortality and all‐cause readmissions, little insight is available into risk factors associated with ACS and revascularization after AMI.
Methods and Results
In a multicenter AMI registry, we examined the rates and predictors of rehospitalizations for ACS and revascularization within the year after AMI among 3283 patients. Staged revascularization procedures were excluded. Kaplan–Meier estimated rates of rehospitalization due to ACS and revascularization were 6.8% and 4.1%, respectively. In hierarchical, multivariable models, the strongest predictors of rehospitalization for ACS were coronary artery bypass graft prior to AMI hospitalization (hazard ratio [HR] 2.12, 95% CI 1.45 to 3.10), female sex (HR 1.67, 95% CI 1.23 to 2.25), and in‐hospital PCI (HR 1.85, 95% CI 1.28 to 2.69). The strongest predictors of subsequent revascularization were multivessel disease (HR 2.89, 95% CI 1.90 to 4.39) and in‐hospital percutaneous coronary intervention with a bare metal stent (HR 2.08, 95% CI 1.19 to 3.63). The Global Registry of Acute Coronary Events mortality risk score was not associated with the risk of rehospitalization for ACS or revascularization.
Conclusions
Unique characteristics are associated with admissions for ACS and revascularization, as compared with survival. These multivariable risk predictors may help identify patients at high risk for ACS and revascularization, in whom intensification of secondary prevention therapies or closer post‐AMI follow‐up may be warranted.
Original languageEnglish
JournalJournal of the American Heart Association
Volume4
Issue number2
DOIs
Publication statusPublished - 2015

Keywords

  • myocardial infarction
  • rehospitalization
  • revascularization
  • unstable angina

Cite this

Arnold, Suzanne V. ; Smolderen, Kim G. ; Kennedy, Kevin F. ; Li, Yan ; Shore, Supriya ; Stolker, Joshua M. ; Wang, Tracy Y. ; Jones, Philip G. ; Zhao, Zhenxiang ; Spertus, John A. / Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 2.
@article{b31ff492c5bc499482c0163ab3a67c5d,
title = "Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction",
abstract = "Background Rehospitalizations for acute coronary syndromes (ACS) and coronary revascularization after an acute myocardial infarction (AMI) are not only common and costly but can also impact patients’ quality of life. In contrast to mortality and all‐cause readmissions, little insight is available into risk factors associated with ACS and revascularization after AMI.Methods and Results In a multicenter AMI registry, we examined the rates and predictors of rehospitalizations for ACS and revascularization within the year after AMI among 3283 patients. Staged revascularization procedures were excluded. Kaplan–Meier estimated rates of rehospitalization due to ACS and revascularization were 6.8{\%} and 4.1{\%}, respectively. In hierarchical, multivariable models, the strongest predictors of rehospitalization for ACS were coronary artery bypass graft prior to AMI hospitalization (hazard ratio [HR] 2.12, 95{\%} CI 1.45 to 3.10), female sex (HR 1.67, 95{\%} CI 1.23 to 2.25), and in‐hospital PCI (HR 1.85, 95{\%} CI 1.28 to 2.69). The strongest predictors of subsequent revascularization were multivessel disease (HR 2.89, 95{\%} CI 1.90 to 4.39) and in‐hospital percutaneous coronary intervention with a bare metal stent (HR 2.08, 95{\%} CI 1.19 to 3.63). The Global Registry of Acute Coronary Events mortality risk score was not associated with the risk of rehospitalization for ACS or revascularization.Conclusions Unique characteristics are associated with admissions for ACS and revascularization, as compared with survival. These multivariable risk predictors may help identify patients at high risk for ACS and revascularization, in whom intensification of secondary prevention therapies or closer post‐AMI follow‐up may be warranted.",
keywords = "myocardial infarction, rehospitalization, revascularization, unstable angina",
author = "Arnold, {Suzanne V.} and Smolderen, {Kim G.} and Kennedy, {Kevin F.} and Yan Li and Supriya Shore and Stolker, {Joshua M.} and Wang, {Tracy Y.} and Jones, {Philip G.} and Zhenxiang Zhao and Spertus, {John A.}",
year = "2015",
doi = "10.1161/JAHA.114.001352",
language = "English",
volume = "4",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction. / Arnold, Suzanne V.; Smolderen, Kim G.; Kennedy, Kevin F.; Li, Yan; Shore, Supriya; Stolker, Joshua M.; Wang, Tracy Y.; Jones, Philip G.; Zhao, Zhenxiang; Spertus, John A.

In: Journal of the American Heart Association, Vol. 4, No. 2, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction

AU - Arnold, Suzanne V.

AU - Smolderen, Kim G.

AU - Kennedy, Kevin F.

AU - Li, Yan

AU - Shore, Supriya

AU - Stolker, Joshua M.

AU - Wang, Tracy Y.

AU - Jones, Philip G.

AU - Zhao, Zhenxiang

AU - Spertus, John A.

PY - 2015

Y1 - 2015

N2 - Background Rehospitalizations for acute coronary syndromes (ACS) and coronary revascularization after an acute myocardial infarction (AMI) are not only common and costly but can also impact patients’ quality of life. In contrast to mortality and all‐cause readmissions, little insight is available into risk factors associated with ACS and revascularization after AMI.Methods and Results In a multicenter AMI registry, we examined the rates and predictors of rehospitalizations for ACS and revascularization within the year after AMI among 3283 patients. Staged revascularization procedures were excluded. Kaplan–Meier estimated rates of rehospitalization due to ACS and revascularization were 6.8% and 4.1%, respectively. In hierarchical, multivariable models, the strongest predictors of rehospitalization for ACS were coronary artery bypass graft prior to AMI hospitalization (hazard ratio [HR] 2.12, 95% CI 1.45 to 3.10), female sex (HR 1.67, 95% CI 1.23 to 2.25), and in‐hospital PCI (HR 1.85, 95% CI 1.28 to 2.69). The strongest predictors of subsequent revascularization were multivessel disease (HR 2.89, 95% CI 1.90 to 4.39) and in‐hospital percutaneous coronary intervention with a bare metal stent (HR 2.08, 95% CI 1.19 to 3.63). The Global Registry of Acute Coronary Events mortality risk score was not associated with the risk of rehospitalization for ACS or revascularization.Conclusions Unique characteristics are associated with admissions for ACS and revascularization, as compared with survival. These multivariable risk predictors may help identify patients at high risk for ACS and revascularization, in whom intensification of secondary prevention therapies or closer post‐AMI follow‐up may be warranted.

AB - Background Rehospitalizations for acute coronary syndromes (ACS) and coronary revascularization after an acute myocardial infarction (AMI) are not only common and costly but can also impact patients’ quality of life. In contrast to mortality and all‐cause readmissions, little insight is available into risk factors associated with ACS and revascularization after AMI.Methods and Results In a multicenter AMI registry, we examined the rates and predictors of rehospitalizations for ACS and revascularization within the year after AMI among 3283 patients. Staged revascularization procedures were excluded. Kaplan–Meier estimated rates of rehospitalization due to ACS and revascularization were 6.8% and 4.1%, respectively. In hierarchical, multivariable models, the strongest predictors of rehospitalization for ACS were coronary artery bypass graft prior to AMI hospitalization (hazard ratio [HR] 2.12, 95% CI 1.45 to 3.10), female sex (HR 1.67, 95% CI 1.23 to 2.25), and in‐hospital PCI (HR 1.85, 95% CI 1.28 to 2.69). The strongest predictors of subsequent revascularization were multivessel disease (HR 2.89, 95% CI 1.90 to 4.39) and in‐hospital percutaneous coronary intervention with a bare metal stent (HR 2.08, 95% CI 1.19 to 3.63). The Global Registry of Acute Coronary Events mortality risk score was not associated with the risk of rehospitalization for ACS or revascularization.Conclusions Unique characteristics are associated with admissions for ACS and revascularization, as compared with survival. These multivariable risk predictors may help identify patients at high risk for ACS and revascularization, in whom intensification of secondary prevention therapies or closer post‐AMI follow‐up may be warranted.

KW - myocardial infarction

KW - rehospitalization

KW - revascularization

KW - unstable angina

U2 - 10.1161/JAHA.114.001352

DO - 10.1161/JAHA.114.001352

M3 - Article

VL - 4

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

ER -