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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

All-Cause Readmission and Repeat Revascularization After Percutaneous Coronary Intervention in a Cohort of Medicare Patients

Jeptha P. Curtis, MD^_*,,_*, Geoffrey Schreiner, BS, Yongfei Wang, MS^_*,, Jersey Chen, MD, MPH^_*,, John A. Spertus, MD, MPH^||, John S. Rumsfeld, MD, PhD^¶, Ralph G. Brindis, MD, MPH^# and Harlan M. Krumholz, MD, SM^_*,,,

^_* Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Connecticut
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
^|| Mid-America Heart Institute, Kansas City, Missouri
^¶ Denver Veterans Affairs Hospital, Denver, Colorado
^# Oakland Kaiser Medical Center, Oakland, California

Manuscript received March 17, 2009; accepted April 8, 2009.

^_* Reprint requests and correspondence: Dr. Jeptha P. Curtis, Yale University School of Medicine, Section of Cardiovascular Disease, 333 Cedar Street FMP-3, New Haven, Connecticut 06520 (Email: jeptha.curtis{at}yale.edu).

Objectives: The purpose of this study was to report on the all-cause readmission and repeat revascularization rates after percutaneous coronary intervention (PCI).

Background: Although PCIs are frequently performed, 30-day rates of readmission and repeat revascularization after PCI are not known.

Methods: Retrospective analysis of a cohort of Medicare fee-for-service admissions associated with a PCI in 2005. Primary outcomes were 30-day all-cause readmission rates and 30-day readmission rates associated with a revascularization procedure.

Results: A total of 315,241 PCI procedures performed at 1,108 hospitals were included in the analysis. The all-cause 30-day readmission rate was 14.6%, and the all-cause 30-day mortality rate was 1.0%. All-cause 30-day mortality among readmitted patients was higher than patients who were not readmitted (3.6% vs. 0.6%; p < 0.001). The 30-day readmission rate of acute myocardial infarction (AMI) patients was significantly higher than that of non-AMI patients (AMI 17.5%, non-AMI 13.6%, p < 0.001). Among all patients readmitted within 30 days after the index PCI, 27.5% had an associated revascularization procedure (PCI 25.8%, coronary artery bypass grafting 1.7%). The median readmission rates varied across hospitals, from 8.9% in the lowest decile to 22.0% in the highest decile.

Conclusions: A substantial proportion of PCI patients are readmitted within 30 days of discharge, and readmission rates vary widely across hospitals. Readmissions within 30 days of an index PCI procedure were associated with a significantly higher 30-day mortality rate, and more than one-quarter of such readmissions resulted in a repeat revascularization procedure. These findings warrant further attention to determine whether these readmissions are preventable.

Key Words: angioplasty • quality of care • readmission

Abbreviations and Acronyms   AMI = acute myocardial infarction   FFS = fee for service   ICD-9-CM = International Classification of Diseases-9th Revision-Clinical Modification   PCI = percutaneous coronary intervention

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