Incidence, Clinical Presentation, and Causes of 30-Day Readmission Following Hospitalization With Spontaneous Coronary Artery Dissection

JACC Cardiovasc Interv. 2020 Apr 27;13(8):921-932. doi: 10.1016/j.jcin.2019.12.033.

Abstract

Objectives: The aim of this study was to investigate the impact of spontaneous coronary artery dissection (SCAD) on 30-day readmission rates following hospitalization with acute myocardial infarction (AMI) using a national database.

Background: AMI in the setting of SCAD represents an uncommon type of myocardial infarction with limited data on short-term outcomes.

Methods: All hospitalizations with primary or index diagnoses of AMI from 2010 to 2015 in the Nationwide Readmissions Database were queried. The primary outcome was overall 30-day readmission rates in both SCAD and non-SCAD cohorts. Propensity score matching (1:2) was conducted.

Results: A total of 2,654,087 patients with AMI were included in the final analysis, of whom 1,386 (0.052%) were diagnosed with SCAD. SCAD was associated with a higher readmission rate in the SCAD cohort (12.3% vs. 9.9%; p = 0.022). The main causes of readmissions in the SCAD cohort were cardiac causes (80.6%), and AMI was the most common cardiac cause (44.8%), followed by chest pain (20.1%) and arrhythmia (12.7%). Among the SCAD readmissions, 50.6% patients were readmitted in the first week post-discharge, with 54.5% of AMI readmissions occurring in the first 2 days post-discharge.

Conclusions: The incidence of 30-day readmission following AMI and SCAD is nontrivial and occurs early post-discharge. Most readmissions are due to cardiac causes, especially AMI. Targeted management approaches are needed to diminish the high rates of readmission and early recurrent AMI.

Keywords: acute myocardial infarction; coronary interventions; outcomes; readmission; spontaneous coronary artery dissection.

MeSH terms

  • Aged
  • Coronary Vessel Anomalies / diagnostic imaging
  • Coronary Vessel Anomalies / mortality
  • Coronary Vessel Anomalies / therapy*
  • Databases, Factual
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Length of Stay
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Patient Admission*
  • Patient Readmission*
  • Recurrence
  • Risk Factors
  • Time Factors
  • United States / epidemiology
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / mortality
  • Vascular Diseases / therapy

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous