Abstract P68: Comparison of Rehospitalization Rates and Risk for Acute Coronary Syndrome (ACS) and Elective Percutaneous Coronary Intervention (PCI) Patients
Authors: Winget Melissa , Zagar Anthony , Zhao Zhenxiang , Samant Navendu , Borah Bijan 
Published: March 2022

Methods:
Patients, aged ≥18, with ACS diagnosis managed medically (MM), or by PCI or by coronary artery bypass graft (CABG), or no ACS with elective PCI (E-PCI), were identified from a linked managed care and hospital database from 01/2004 - 12/2006.

Results:
Of 4674 patients, 3329 (71.2%) were male, aged 57.6±10.4 with a Charlson Comorbidity Index (CCI) of 1.1±1.6. Of 4535 patients followed ≥30 days, compared to the PCI cohort (n=1811), MM patients (n=1342) had lower rates of cardiac related (64 [4.8%] vs. 140 [7.7%];
P
<0.001) and coronary intervention (30 [2.2%] vs. 90 [5.0%];
P
<0.001) rehospitalizations; CABG patients (n=368) had a lower rate of revascularization (3 [0.8%] vs. 90 [5.0%];
P
<0.001), with no difference in rehospitalization rates for E-PCI (n=1014). Among 3282 patients followed 12 months, compared to the PCI cohort (n=1339), MM patients (n=932) had fewer cardiac (155 [16.6%] vs. 323 [24.1%];
P
<0.001) and coronary intervention (57 [6.1%] vs. 186 [13.9%];
P
<0.001) rehospitalizations; CABG patients (n=265) had less revascularizations (17 [6.4%] vs. 186 [13.9%];
P
<0.001) while E-PCI (n=746) had similar rehospitalization rates. Cox regression (
Table 1
) showed compared to PCI; MM, CABG and E-PCI cohorts had a lower risk of cardiac related rehospitalization (
P
<0.05), while MM and CABG cohorts had a lower risk of coronary intervention rehospitalization (
P
<0.001).

Conclusion:
Compared to ACS PCI patients, the adjusted risk for cardiac rehospitalization was lower for MM, CABG and E-PCI cohorts with a lower rate for MM patients while both the risk and rate for coronary intervention rehospitalization were lower for MM and CABG with no differences in the E-PCI cohort.

Table 1:

Significant Predictors of Rehospitalization Risk (Cox Regression)

Risk Of Cardiac Related Rehospitalization
Risk of MI Rehospitalization
Risk of Coronary Intervention (PCI or CABG) Rehospitalization

Variables
Hazard Ratio
95% CI
Hazard Ratio
95% CI
Hazard Ratio
95% CI

Medically Managed (Reference: PCI cohort)

0.639

‡

[0.539,0.756]
0.694
[0.420,1.148]

0.422

‡

[0.328,0.542]

CABG (Reference: PCI cohort)

0.782

*

[0.619,0.989]
0.683
[0.343,1.360]

0.420

‡

[0.284,0.622]

Elective PCI (Reference: PCI cohort)

0.811

*

[0.687,0.956]
0.870
[0.525,1.441]
0.898
[0.725,1.113]

Male Gender
0.922
[0.808,1.052]
1.324
[0.872,2.012]
1.005
[0.834,1.212]

1<CCI<3 ; Reference: CCI<=1

1.270

†

[1.072,1.503]
1.369
[0.820,2.284]
1.179
[0.930,1.495]

CCI>=3 ; Reference: CCI<=1

1.630

‡

[1.324,2.007]

2.683

‡

[1.529,4.708]

1.499

†

[1.113,2.019]

STEMI

1.255

†

[1.078,1.460]

2.225

‡

[1.482,3.340]
1.197
[0.973,1.473]

Prior Diabetes

1.222

*

[1.005,1.486]
1.151
[0.658,2.014]
1.173
[0.894,1.539]

Prior Hypertension
1.093
[0.947,1.262]

1.706

*

[1.106,2.633]
1.127
[0.924,1.375]

Baseline Beta-Blocker Use

1.270

‡

[1.108,1.456]
1.420
[0.953,2.115]
1.187
[0.982,1.435]

Baseline Statin Use

0.846

*

[0.742,0.964]

0.663

*

[0.451,0.973]

0.826

*

[0.690,0.990]

Baseline Proton Pump Inhibitor Use
0.967
[0.820,1.140]

1.558

*

[1.007,2.412]
1.161
[0.931,1.449]

Baseline Clopidogrel Use

1.271

†

[1.066,1.516]
1.443
[0.861,2.419]
1.146
[0.901,1.459]

Baseline Diuretics Use

1.167

*

[1.010,1.348]
0.666
[0.430,1.034]
0.975
[0.795,1.195]

Baseline Insulin Use

1.325

*

[1.066,1.647]
0.949
[0.489,1.844]

1.432

*

[1.064,1.927]

Baseline Nitroglycerin Use
1.131
[0.956,1.337]
0.770
[0.436,1.360]

1.348

†

[1.077,1.686]

Baseline Warfarin Use

1.469

†

[1.139,1.895]
1.858
[0.926,3.730]
1.023
[0.676,1.547]

*

P
< 0.05,

†

P
< 0.01,

‡

P
< 0.001.