Abstract 19127: The Effect of Frailty on 30 Day Rate of Readmission Among Patients With N/Stemi and Spontaneous Coronary Artery Dissection

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) can present as myocardial infarction or sudden death, particularly in young patients. SCAD is primarily diagnosed on angiography thus the majority of patients present with findings of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Hypothesis: We sought to determine the 30-Day readmission rate (30-DRr) for STEMI/NSTEMI in frail individuals with SCAD and its impact on healthcare utilization and economic burden in the United States. Methods: Using the 2020 National Readmission Database and International Classification of Diseases, 10th revision (ICD-10) codes, a retrospective study of patient discharges with N/STEMI as a primary diagnosis and with SCAD as a secondary diagnosis. The primary outcome was 30-DRr, while secondary outcomes were readmission mortality rate, length of stay, and resource utilization defined by hospital charge (HC). Outcomes were analyzed to compare frail and non-frail individuals. Results: A total of 19,277 index hospitalizations for N/STEMI with a secondary diagnosis of SCAD were identified. The mean age on index admission was 59.53 ± 12.10 years, 57.16% (11,018) were female, and the in-hospital mortality rate was 5.84% (n = 1,125.70). There were 4,068 (21.10%) frail individuals identified. The 30-DRr was 13.30% for frail patients vs 6.51% for non-frail patients (adjusted p < 0.001). There was an 18.48% in-hospital mortality for frail individuals vs 2.46% mortality for non-frail individuals (adjusted p < 0.001). There were also significant increases in length of stay for frail patients, 9.58 days, vs 3.49 days for non-frail patients (adjusted p < 0.001), and total HC for frail patients $61,068.09 when compared to non-frail, $25,248.12 (adjusted p < 0.001). Conclusions: Frail patients with SCAD are at higher risk for readmission when compared to non-frail individuals with SCAD. The implications of this data include the possible implementation of closer follow-up with cardiology post-discharge, and need for further studies into the clinical course, interventions, and outcomes associated with SCAD.