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. 2022 Sep 28;19(9):631-642.
doi: 10.11909/j.issn.1671-5411.2022.09.006.

In-hospital outcomes and readmission in older adults treated with percutaneous coronary intervention for stable ischemic heart disease

Dae Yong Park  1 , Jonathan M Hanna  2 , Sumeet Kadian  3 , Mannat Kadian  4 , W Schuyler Jones  5 , Abdulla Al Damluji  6 , Ajar Kochar  7 , Jeptha P Curtis  8 , Michael G Nanna  8
Affiliations

In-hospital outcomes and readmission in older adults treated with percutaneous coronary intervention for stable ischemic heart disease

Dae Yong Park et al. J Geriatr Cardiol. .

Abstract

Background: Percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) in older adults requires a meticulous assessment of procedural risks and benefits, but contemporary data on outcomes in this population is lacking. Therefore, we examined the risk of near-term readmission, bleeding, and mortality in high-risk cohort of older adults undergoing inpatient PCI for SIHD.

Methods: We analyzed the National Readmissions Database from 2017 to 2018 to identify index hospitalizations in which PCI was performed for SIHD. Patients were stratified into those ≥ 75 years old (older adults) and those < 75 years old. The primary outcome was 90-day readmission. Secondary outcomes included in-hospital mortality, hospital length of stay (LOS), and total hospital charge.

Results: A total of 74,516 patients underwent inpatient PCI for SIHD, of whom 24,075 were older adults. Older adult patients had higher odds of in-hospital mortality (OR = 2.00, 95% CI: 1.68-2.38), intracranial hemorrhage (OR = 2.03, 95% CI: 1.24-3.34), and gastrointestinal hemorrhage (OR = 1.72, 95% CI: 1.43-2.07) during index hospitalization, with longer LOS and in-hospital charge. Older adults also experienced a higher hazard of 90-day readmission for any cause (HR = 1.61, 95% CI: 1.57-1.66) and cardiovascular causes (HR = 1.84, 95% CI: 1.77-1.91).

Conclusion: Older adults undergoing inpatient PCI for SIHD were at increased risk for in-hospital mortality, periprocedural morbidities, higher cost, and readmissions compared with younger adults. Understanding these differences may improve shared decision-making for patients with SIHD being considered for PCI.

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Figures

Figure 1
Figure 1
Disposition from index hospitalization.
Figure 2
Figure 2
Kaplan-Meier curves of all-cause and cardiovascular readmissions after inpatient PCI in patients ≥ 75 years versus < 75 years.
Figure 3
Figure 3
Potential risk factors of 90-day readmission after inpatient PCI in patients ≥ 75 years.
See this image and copyright information in PMC

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