title: Causes of short-term readmission after percutaneous coronary intervention.
abstract: BACKGROUND
  Rehospitalization within 30 days after an admission for percutaneous coronary intervention (PCI) is common, costly, and a future target for Medicare penalties. Causes of readmission after PCI are largely unknown.
  
  
  RESULTS
  To illuminate the causes of PCI readmissions, patients with PCI readmitted within 30 days of discharge between 2007 and 2011 at 2 hospitals were identified, and their medical records were reviewed. Of 9288 PCIs, 9081 (97.8%) were alive at the end of the index hospitalization. Of these, 893 patients (9.8%) were readmitted within 30 days of discharge and included in the analysis. Among readmitted patients, 341 patients (38.1%) were readmitted for evaluation of recurrent chest pain or other symptoms concerning for angina, whereas 59 patients (6.6%) were readmitted for staged PCI without new symptoms. Complications of PCI accounted for 60 readmissions (6.7%). For cases in which chest pain or other symptoms concerning for angina prompted the readmission, 21 patients (6.2%) met criteria for myocardial infarction, and repeat PCI was performed in 54 patients (15.8%). The majority of chest pain patients (288; 84.4%) underwent ≥1 diagnostic imaging test, most commonly coronary angiography, and only 9 (2.6%) underwent target lesion revascularization.
  
  
  CONCLUSIONS
  After PCI, readmissions within 30 days were seldom related to PCI complications but often for recurrent chest pain. Readmissions with recurrent chest pain infrequently met criteria for myocardial infarction but were associated with high rates of diagnostic testing.
authors.affiliation: From the Cardiology Division (J.H.W., C.O'B., R.W.Y.), Department of Medicine (J.H.W., C.O'B., R.W.Y., J.B.S.), and Laboratory of Computer Science (A.H.Z., J.L.), Massachusetts General Hospital, Harvard Medical School, Boston; Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.Z., S.-L.T.N.); Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.); and Harvard Clinical Research Institute, Boston, MA (L.M., R.W.Y.).
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Strom
authors.forename: Cashel
authors.initials: C
authors.lastname: O'Brien
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Zai
authors.forename: Jennifer
authors.initials: J
authors.lastname: Luttrell
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Katya
authors.initials: K
authors.lastname: Zelevinsky
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology / Q000601:surgery; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery; D009204:Myocardial Revascularization; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D060891:Root Cause Analysis; D016019:Survival Analysis; D013997:Time Factors; D014481:United States
keywords: outcome assessment (health care); patient readmission; percutaneous coronary intervention