Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Multi-Center Randomized Trial

Ernest Spitzer, Martina Frei, Serge Zaugg, Susanne Hadorn, Henning Kelbaek, Miodrag Ostojic, Andreas Baumbach, David Tüller, Marco Roffi, Thomas Engstrom, Giovanni Pedrazzini, Vladan Vukcevic, Michael Magro, Ran Kornowski, Thomas F. Lüscher, Clemens von Birgelen, Dik Heg, Stephan Windecker, Lorenz Räber

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Abstract

Background - Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Methods and Results - In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7%) and in 79 patients (6.9%), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4%), recurrent chest pain with ischemia and coronary intervention (16.9%), and ischemic events (16.9%). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5%), infections (14.3%), and cancer (9.1%). On multivariate analysis, left ventricular ejection fraction (22% increase in the rate of RHs per 10% decrease; P=0.03) and angiographic myocardial infarction Syntax score (34% increase per 10-point increase; P=0.01) were independent predictors of unplanned cardiac RHs. Age emerged as the only independent predictor of unplanned noncardiac RHs. Regional differences for unplanned cardiac RHs were observed.

Conclusions - Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12% with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7% with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention.

Original languageEnglish
Article numbere005926
JournalJournal of the American Heart Association
Volume6
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

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Percutaneous Coronary Intervention
Chest Pain
Stroke Volume
Stents
Ischemia
Hemorrhage
Secondary Prevention
ST Elevation Myocardial Infarction
Multivariate Analysis
Randomized Controlled Trials
Metals
Myocardial Infarction
Economics
Quality of Life
Infection
Neoplasms

Keywords

  • Cardiac hospitalization
  • Coronary artery disease
  • Myocardial infarction
  • Percutaneous coronary intervention
  • Rehospitalization

Cite this

Spitzer, Ernest ; Frei, Martina ; Zaugg, Serge ; Hadorn, Susanne ; Kelbaek, Henning ; Ostojic, Miodrag ; Baumbach, Andreas ; Tüller, David ; Roffi, Marco ; Engstrom, Thomas ; Pedrazzini, Giovanni ; Vukcevic, Vladan ; Magro, Michael ; Kornowski, Ran ; Lüscher, Thomas F. ; von Birgelen, Clemens ; Heg, Dik ; Windecker, Stephan ; Räber, Lorenz. / Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction : Results From a Multi-Center Randomized Trial. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 8.
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title = "Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Multi-Center Randomized Trial",
abstract = "Background - Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Methods and Results - In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7{\%}) and in 79 patients (6.9{\%}), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4{\%}), recurrent chest pain with ischemia and coronary intervention (16.9{\%}), and ischemic events (16.9{\%}). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5{\%}), infections (14.3{\%}), and cancer (9.1{\%}). On multivariate analysis, left ventricular ejection fraction (22{\%} increase in the rate of RHs per 10{\%} decrease; P=0.03) and angiographic myocardial infarction Syntax score (34{\%} increase per 10-point increase; P=0.01) were independent predictors of unplanned cardiac RHs. Age emerged as the only independent predictor of unplanned noncardiac RHs. Regional differences for unplanned cardiac RHs were observed. Conclusions - Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12{\%} with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7{\%} with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention.",
keywords = "Cardiac hospitalization, Coronary artery disease, Myocardial infarction, Percutaneous coronary intervention, Rehospitalization",
author = "Ernest Spitzer and Martina Frei and Serge Zaugg and Susanne Hadorn and Henning Kelbaek and Miodrag Ostojic and Andreas Baumbach and David T{\"u}ller and Marco Roffi and Thomas Engstrom and Giovanni Pedrazzini and Vladan Vukcevic and Michael Magro and Ran Kornowski and L{\"u}scher, {Thomas F.} and {von Birgelen}, Clemens and Dik Heg and Stephan Windecker and Lorenz R{\"a}ber",
year = "2017",
month = "8",
day = "1",
doi = "10.1161/JAHA.117.005926",
language = "English",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "8",

}

Spitzer, E, Frei, M, Zaugg, S, Hadorn, S, Kelbaek, H, Ostojic, M, Baumbach, A, Tüller, D, Roffi, M, Engstrom, T, Pedrazzini, G, Vukcevic, V, Magro, M, Kornowski, R, Lüscher, TF, von Birgelen, C, Heg, D, Windecker, S & Räber, L 2017, 'Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Multi-Center Randomized Trial' Journal of the American Heart Association, vol. 6, no. 8, e005926. https://doi.org/10.1161/JAHA.117.005926

Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction : Results From a Multi-Center Randomized Trial. / Spitzer, Ernest; Frei, Martina; Zaugg, Serge; Hadorn, Susanne; Kelbaek, Henning; Ostojic, Miodrag; Baumbach, Andreas; Tüller, David; Roffi, Marco; Engstrom, Thomas; Pedrazzini, Giovanni; Vukcevic, Vladan; Magro, Michael; Kornowski, Ran; Lüscher, Thomas F.; von Birgelen, Clemens; Heg, Dik; Windecker, Stephan; Räber, Lorenz.

In: Journal of the American Heart Association, Vol. 6, No. 8, e005926, 01.08.2017.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction

T2 - Results From a Multi-Center Randomized Trial

AU - Spitzer, Ernest

AU - Frei, Martina

AU - Zaugg, Serge

AU - Hadorn, Susanne

AU - Kelbaek, Henning

AU - Ostojic, Miodrag

AU - Baumbach, Andreas

AU - Tüller, David

AU - Roffi, Marco

AU - Engstrom, Thomas

AU - Pedrazzini, Giovanni

AU - Vukcevic, Vladan

AU - Magro, Michael

AU - Kornowski, Ran

AU - Lüscher, Thomas F.

AU - von Birgelen, Clemens

AU - Heg, Dik

AU - Windecker, Stephan

AU - Räber, Lorenz

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background - Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Methods and Results - In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7%) and in 79 patients (6.9%), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4%), recurrent chest pain with ischemia and coronary intervention (16.9%), and ischemic events (16.9%). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5%), infections (14.3%), and cancer (9.1%). On multivariate analysis, left ventricular ejection fraction (22% increase in the rate of RHs per 10% decrease; P=0.03) and angiographic myocardial infarction Syntax score (34% increase per 10-point increase; P=0.01) were independent predictors of unplanned cardiac RHs. Age emerged as the only independent predictor of unplanned noncardiac RHs. Regional differences for unplanned cardiac RHs were observed. Conclusions - Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12% with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7% with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention.

AB - Background - Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.Methods and Results - In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7%) and in 79 patients (6.9%), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4%), recurrent chest pain with ischemia and coronary intervention (16.9%), and ischemic events (16.9%). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5%), infections (14.3%), and cancer (9.1%). On multivariate analysis, left ventricular ejection fraction (22% increase in the rate of RHs per 10% decrease; P=0.03) and angiographic myocardial infarction Syntax score (34% increase per 10-point increase; P=0.01) were independent predictors of unplanned cardiac RHs. Age emerged as the only independent predictor of unplanned noncardiac RHs. Regional differences for unplanned cardiac RHs were observed. Conclusions - Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12% with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7% with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention.

KW - Cardiac hospitalization

KW - Coronary artery disease

KW - Myocardial infarction

KW - Percutaneous coronary intervention

KW - Rehospitalization

UR - http://www.scopus.com/inward/record.url?scp=85030711879&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.005926

DO - 10.1161/JAHA.117.005926

M3 - Article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 8

M1 - e005926

ER -