Gender Impact on 30-Day Readmissions After Hospitalization With Acute Myocardial Infarction Complicated by Cardiogenic Shock (from the 2013 to 2014 National Readmissions Database)

Abstract

Previous studies have suggested that women are more likely to have increased risk of readmissions after acute myocardial infarction (AMI); however, this difference has not been examined in the setting of AMI complicated by cardiogenic shock. Thus, we aimed to compare 30-day readmissions in women versus men initially admitted with AMI complicated with cardiogenic shock. In this observational study, we used the Nationwide Readmissions Databases years 2013 and 2014 to identify subjects who were initially hospitalized with a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive. The 30-day readmission rates between women and men were compared using a multivariate Cox regression model adjusting for variable co-morbidities, as well as a propensity-matched analysis. Of 1,116,933 patients who had AMI, 39,807 (3.6%) had cardiogenic shock and were discharged alive. The rates of in-hospital procedures such as percutaneous coronary intervention, coronary artery bypass grafting, and intra-aortic balloon placement were less frequent in women. Thirty-day readmissions were higher in women (20.7%) than in men (17.6%), after adjustment for various co-morbidities (hazards ratio 1.09, 95% confidence interval 1.00 to 1.19, p = 0.04), and in the propensity-matched analysis (hazards ratio 1.10, 95% confidence interval 1.01 to 1.21, p = 0.04). In conclusion, women are at a higher risk of 30-day readmissions after AMI complicated with cardiogenic shock.