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Hospital readmission in the first 30 days following percutaneous coronary intervention (PCI) is rarely related to the index admission or complications from the procedure, according to a registry study published in the March 2013 issue of the Journal of the American College of Cardiology: Cardiovascular Interventions. The authors suggest that readmission rates should not be used as a quality metric for PCI outcomes.

Gregory W. Yost, DO, of Geisinger Medical Center (Danville, PA), and colleagues looked at 3,255 patients in the American College of Cardiology National Cardiovascular Data Registry who underwent PCI between January 1, 2007, and April 12, 2010.

A total of 262 patients (8.0%) were readmitted to the hospital within 30 days, and all but 1 had medical records available for analysis. Ten percent of readmissions were elective. Reasons for readmission were as follows:

• Complications during or after PCI: 11.9%
• Noncardiac causes related to index admission: 12.2%
• Cardiac causes related to index admission: 35.6%
• Causes unrelated to index admission: 40.2%

Among the patients readmitted for PCI complications, 4.6% had an in-stent thrombosis, 3.1% had vascular access complications, and 0.8% had coronary dissection. The most common reason for readmission unrelated to the index hospitalization was noncardiac chest pain (10.3%), followed by gastrointestinal reflux (7.7%), infection (3.4%), and neurologic problems (3.1%).

Multivariate analysis showed that prior valve surgery was the strongest predictor of readmission. Indication for the initial PCI also was predictive, with stable angina patients showing the lowest risk, while peripheral artery disease and diabetes increased the odds of readmission (table 1).

Table 1. Independent Predictors of Readmission

Not a Useful Quality Indicator

Dr. Yost and colleagues note that the rarity of PCI complications leading to readmission is likely due to decreased rates of stent thrombosis with newer generation stents, as well as adoption of radial access techniques at the study center. “Although PCI complications have not been eliminated, even their complete eradication would minimally decrease the overall PCI readmission rate,” they write.

In the ongoing debate over whether or not 30-day readmission rates should be used as a quality indicator—and ultimately impact hospital reimbursement—results like these may offer insight, the researchers note. If readmission is generally unrelated to the index procedure, they say, such metrics may penalize hospitals unnecessarily.

“Our data do not support use of readmission after PCI as an indicator of the quality of care during the index admission,” the authors conclude.

In an editorial accompanying the study, Warren K. Laskey, MD, MPH, of the University of New Mexico (Albuquerque, NM), and Mark J. Ricciardi, MD, of Northwestern University (Chicago, IL), agree that 30-day readmission is too complicated a variable to consider as a yes-or-no proposition.

“Modifiable factors, with a few notable exceptions, appear to be a minority among covariates associated with risk of readmission,” they write, pointing out that readmission rates vary among and within a number of recent studies and that, importantly, the “other” category of readmission causes remains difficult to understand and quantify. “What matters greatly are the numerous, and at present, imponderables and unknowns that reflect ‘process,’ ‘system,’ ‘quality,’ and ‘place.’”

Without such details, “the true risk for readmission, and its determinants, should remain a matter for further study rather than legislative fiat,” Drs. Laskey and Ricciardi conclude.

2. Laskey WK, Ricciardi MJ. 30-day readmission rate following percutaneous coronary intervention. J Am Coll Cardiol Intv. 2013;6:245-246.

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