Trends and predictors of recurrent acute coronary syndrome hospitalizations and unplanned revascularization after index acute myocardial infarction treated with percutaneous coronary intervention.

Authors:
Matias B Yudi
Matias B Yudi
Australia; Alfred Hospital
Australia
David J Clark
David J Clark
J. Craig Venter Institute
United States
Omar Farouque
Omar Farouque
Austin Hospital
Australia
Nick Andrianopoulos
Nick Andrianopoulos
Deakin University
Australia
Andrew E Ajani
Andrew E Ajani
Washington Hospital Center
United States
Angela Brennan
Angela Brennan
Monash University
Australia
Jeffrey Lefkovits
Jeffrey Lefkovits
Royal Melbourne Hospital
Melanie Freeman
Melanie Freeman
St. Paul's Hospital
Vancouver | Canada

Am Heart J 2019 Mar 5;212:134-143. Epub 2019 Mar 5.

Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia. Electronic address:

Background: Repeat hospitalizations for recurrent acute coronary syndrome (ACS) or unplanned revascularization after acute myocardial infarction (MI) are common, costly and potentially preventable. We aim to describe 10-year trends and identify independent risk factors of these repeat hospitalizations.

Methods: We analyzed data from 9615 patients from the Melbourne Interventional Group registry (2005-2014) who underwent percutaneous coronary intervention (PCI) for their index MI and survived to discharge. Patients with ≥1 hospitalization for recurrent ACS events and/or unplanned revascularization in the year after discharge were included in the recurrent coronary hospitalization group. We assessed yearly trends of recurrent coronary events and identified independent predictors using multivariate analysis.

Results: Recurrent coronary hospitalization occurred in 1175 (12.2%) patients. There was a significant decrease in the rate of recurrent ACS hospitalization (15.3%-7.6%, P for trend <.001) and unplanned revascularization (4.2%-2.1%, P for trend = .01), but not in all-cause re-hospitalizations (P for trend = .28). On multivariate analysis, female gender, diabetes mellitus, previous coronary bypass surgery, previous PCI, reduced ejection fraction, heart failure, multi-vessel coronary disease and obstructive sleep apnea were independent predictors of recurrent coronary hospitalizations (all P < .05).

Conclusions: Recurrent hospitalization for ACS or unplanned revascularization has decreased significantly over the past decade. Risk factors for such events are numerous and largely non-modifiable, however they identify a cohort of patients in whom non-culprit vessel PCI in multi-vessel disease, optimization of left ventricular dysfunction and diabetes management may improve outcomes.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S00028703193004
Publisher Site
http://dx.doi.org/10.1016/j.ahj.2019.02.013DOI Listing
March 2019
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