title: Thirty-day readmission rates after PCI in a metropolitan center in Europe: incidence and impact on prognosis.
abstract: BACKGROUND
  Thirty-day readmission rates after percutaneous coronary intervention (PCI) have been related to adverse prognosis, and represent one of the most investigated indicators of quality of care. These data, however, derive from non-European centers evaluating all-cause readmissions, without stratification for diagnosis.
  
  
  METHODS
  All consecutive patients undergoing PCI at our center from January 2009 to December 2011 were enrolled. Thirty-day readmissions related to postinfarction angina, myocardial infarction, unstable angina or heart failure were defined as acute coronary syndrome (ACS) or heart failure rehospitalizations. Major cardiac adverse event (MACE) was the primary outcome, and its single components (death, myocardial infarction and repeated revascularization) the secondary ones.
  
  
  RESULTS
  A total of 1192 patients were included; among them, 53 (4.7%) were readmitted within 30 days, and 25 (2.1%) were classified as ACS/heart failure related. During hospitalization, patients with ACS/heart failure readmissions were more likely to suffer a periprocedural myocardial infarction (22 vs. 4%; P = 0.012), and to undergo PCI at 30 days (52 vs. 0.5%; P < 0.001). Logistic regression analysis indicated that periprocedural myocardial infarction represented the only independent predictor of an ACS/heart failure readmission [odds ratio (OR) 4.5; 1.1-16.8; P = 0.047]. After a median follow-up of 787 days (434-1027; first and third quartiles), patients with a 30-day ACS/heart failure readmission experienced higher rates of MACE, all-cause death and myocardial infarction (64 vs. 21%, P < 0.001; 28 vs. 6%, P = 0.017; and 20 vs. 2.7%, P < 0.001, respectively). Cox multivariate analysis indicated that ACS/heart failure 30-day readmissions were independently related to an increased risk of all-cause death (OR 3.3; 1.1-8.8; P = 0.02), differently from 30-day non-ACS/heart failure readmissions (OR 3.1; 0.7-12.9; P = 0.12).
  
  
  CONCLUSIONS
  Thirty-day readmissions after PCI in an Italian center are infrequent, and only those patients with ACS/heart failure show a detrimental impact on prognosis who have periprocedural myocardial infarction as the only independent predictor.
authors.affiliation: aDivision of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza bCSI-Piemonte - Direzione Salute - Area Trattamento Dati cSC Programmazione e Controllo di Gestione, Turin, Italy dWegmans Pharmacy, Ithaca, New York, USA.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Davide Giacomo
authors.initials: DG
authors.lastname: Presutti
authors.forename: Marco
authors.initials: M
authors.lastname: Di Cuia
authors.forename: Chiara
authors.initials: C
authors.lastname: Colaci
authors.forename: Federico
authors.initials: F
authors.lastname: Giusto
authors.forename: Flavia
authors.initials: F
authors.lastname: Ballocca
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.forename: Francesco
authors.initials: F
authors.lastname: Colombo
authors.forename: Anna
authors.initials: A
authors.lastname: Gonella
authors.forename: Francesca
authors.initials: F
authors.lastname: Giordana
authors.forename: Giada
authors.initials: G
authors.lastname: Longo
authors.forename: Ilaria
authors.initials: I
authors.lastname: Vilardi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bertaina
authors.forename: Anna
authors.initials: A
authors.lastname: Orlando
authors.forename: Rita
authors.initials: R
authors.lastname: Andrini
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrando
authors.forename: James J
authors.initials: JJ
authors.lastname: DiNicolantonio
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies