Abstract
Introduction: Outcomes within coronary artery disease (CAD) patients after catheter ablation (CA) for atrial fibrillation (AF) remain unclear. In this study, we assessed the impact of stable CAD on 90-day readmission rates following hospitalization for CA of AF. Methods: Using the Nationwide Readmissions Database (NRD), we identified all hospitalizations from the fourth quarter of 2015 to 2019 with a Medicare Severity-Diagnosis Related Group for a percutaneous intracardiac procedure, a procedure code for CA, and a primary discharge diagnosis of AF. Presence of acute coronary syndrome (ACS) at index hospitalization was excluded to define stable CAD and stratify by its presence. Our primary outcome was all-cause 90-day readmission; secondary outcomes included readmission for AF, repeat CA, ACS, and heart failure (HF). We controlled for selection bias using inverse probability of treatment weights (IPTW) and targeted the average treatment effect. Results: An estimated 28,466 hospitalizations for CA for AF were identified, of which 3,171 (11.1%) had concomitant stable CAD. Of note, no index hospitalization included a HF diagnosis, regardless of stable CAD. The 90-day all-cause readmission rate was significantly higher in patients with stable CAD compared to those without stable CAD (18.4% vs. 14.4%, p = .006; Fig. 1) with a significantly higher burden of new ACS (5.3% vs. 1.1%, p < .001) and new HF (17.0% vs. 10.2%, p = .007). AF recurrence rates as 90-day readmission did not differ statistically (21.9% vs. 26.5%, p = .217). Further pooled analysis of all 90-day HF readmissions revealed a significantly higher burden of older patients, with underlying chronic kidney or pulmonary disease, and persistent and chronic AF subtypes. Conclusions: Our large-scale analysis suggests that in patients hospitalized for CA for AF, stable CAD is a marker for adverse prognosis and is associated with a higher 90-day readmission rate and significant burden of new ACS and new HF.
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