Author + information
- Received August 28, 2019
- Revision received October 29, 2019
- Accepted December 19, 2019
- Published online April 20, 2020.
- Mohamed M. Gad, MDa,b,∗,
- Ahmed N. Mahmoud, MDc,∗,
- Anas M. Saad, MDa,
- Najdat Bazarbashi, MDd,
- Keerat R. Ahuja, MDa,
- Antonette K. Karrthik, MDc,
- Islam Y. Elgendy, MDe,
- Akram Y. Elgendy, MDf,
- Creighton W. Don, MD, MPHc,
- Ravi S. Hira, MDc,
- Michael R. Massoomi, MDf,
- Jacqueline Saw, MDg,
- R. David Anderson, MDf and
- Samir R. Kapadia, MDa,∗ ()
- aCleveland Clinic Foundation, Cleveland, Ohio
- bGillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- cDepartment of Cardiovascular Medicine, University of Washington, Seattle, Washington
- dDepartment of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- eDivision of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- fDivision of Cardiovascular Medicine, University of Florida, Gainesville, Florida
- gDivision of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ↵∗Address for correspondence:
Dr. Samir R. Kapadia, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-3, Cleveland, Ohio 44195.
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.
- acute myocardial infarction
- coronary interventions
- spontaneous coronary artery dissection
↵∗ Drs. Gad and Mahmoud contributed equally to this work.
Dr. Anderson is a consultant for Biosense Webster, a Johnson & Johnson Company. Dr. Saw has received research grants for SCAD research from the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, the National Institutes of Health, the University of British Columbia Division of Cardiology, AstraZeneca, Abbott Vascular, St. Jude Medical, and Servier; has been a consultant for Boston Scientific, Abbott Vascular, and St. Jude Medical; has received honoraria for proctoring from Boston Scientific and St. Jude Medical; and has received speaking honoraria for SCAD from AstraZeneca, St. Jude Medical, and Sunovion. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 28, 2019.
- Revision received October 29, 2019.
- Accepted December 19, 2019.
- 2020 American College of Cardiology Foundation
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