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Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction.
J Am Heart Assoc 2015; 4(2)JA

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.

Authors+Show Affiliations

Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.) University of Missouri-Kansas City, Kansas City, MO (S.V.A., K.G.S., J.A.S.).Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.) University of Missouri-Kansas City, Kansas City, MO (S.V.A., K.G.S., J.A.S.).Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.).Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.).Emory School of Medicine, Atlanta, GA (S.S.).Saint Louis University, St Louis, MO (J.M.S.).Duke Clinical Research Institute, Durham, NC (T.Y.W.).Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.).Eli Lilly and Company, Indianapolis, IN (Z.Z.).Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.G.S., K.F.K., Y.L., P.G.J., J.A.S.) University of Missouri-Kansas City, Kansas City, MO (S.V.A., K.G.S., J.A.S.).

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25666368

Citation

Arnold, Suzanne V., et al. "Risk Factors for Rehospitalization for Acute Coronary Syndromes and Unplanned Revascularization Following Acute Myocardial Infarction." Journal of the American Heart Association, vol. 4, no. 2, 2015.
Arnold SV, Smolderen KG, Kennedy KF, et al. Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction. J Am Heart Assoc. 2015;4(2).
Arnold, S. V., Smolderen, K. G., Kennedy, K. F., Li, Y., Shore, S., Stolker, J. M., ... Spertus, J. A. (2015). Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction. Journal of the American Heart Association, 4(2), doi:10.1161/JAHA.114.001352.
Arnold SV, et al. Risk Factors for Rehospitalization for Acute Coronary Syndromes and Unplanned Revascularization Following Acute Myocardial Infarction. J Am Heart Assoc. 2015 Feb 9;4(2) PubMed PMID: 25666368.
* Article titles in AMA citation format should be in sentence-case
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, Y1 - 2015/02/09/ PY - 2015/2/11/entrez PY - 2015/2/11/pubmed PY - 2015/10/30/medline KW - myocardial infarction KW - rehospitalization KW - revascularization KW - unstable angina JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 4 IS - 2 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. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/25666368/Risk_factors_for_rehospitalization_for_acute_coronary_syndromes_and_unplanned_revascularization_following_acute_myocardial_infarction_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.114.001352?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -