Abstract
Left heart catheterization (LHC) for acute coronary syndrome (ACS) is a widely performed procedure. This is challenging to some extent in patients with chronic kidney disease (CKD) especially after receiving intravenous (IV) contrast. We aimed to analyze the rates, predictors and causes of readmission after LHC in ACS patients with co-morbid CKD. The National Readmission Database for 2018 was queried to identify hospitalized adults with ACS and co-diagnosis of CKD who received IV contrast during LHC with exclusion of elective and traumatic admissions. Multivariate logistic and linear regression analysis were used to adjust for possible confounders. A total of 78,168 hospitalizations with ACS and CKD who underwent LHC with 73,603 discharged alive. Within 30-days from discharge, 12,632 (17.2%) were readmitted. Congestive heart failure (CHF) with CKD stage 1-4 (15.5%), non-ST segment elevation myocardial infarction (7.7%), and Sepsis (4.6%) were most common causes of readmissions. Independent predictors of readmission included female sex (aOR 1.16, 95% CI: 1.09 - 1.24, P<0.001), discharge against medical advice (aOR 1.70, 95% CI: 1.23-2.35, P<0.001), CHF (aOR 1.45, 95% CI: 1.35-1.56, P<0.001). Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Predictors of readmission after LHC included female sex, discharge to skilled facility or against medical advice, anemia, hemodialysis, diabetes mellitus, CHF, acute kidney injury, and COPD. Modifiable factors need to be addressed to prevent such a high rate of readmissions.
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