Abstract P68: Comparison of Rehospitalization Rates and Risk for Acute Coronary Syndrome (ACS) and Elective Percutaneous Coronary Intervention (PCI) Patients

Abstract

Methods: Patients, aged ≥18, with ACS diagnosis managed medically (MM), or by PCI or by coronary artery bypass graft (CABG), or no ACS with elective PCI (E-PCI), were identified from a linked managed care and hospital database from 01/2004 - 12/2006. Results: Of 4674 patients, 3329 (71.2%) were male, aged 57.6±10.4 with a Charlson Comorbidity Index (CCI) of 1.1±1.6. Of 4535 patients followed ≥30 days, compared to the PCI cohort (n=1811), MM patients (n=1342) had lower rates of cardiac related (64 [4.8%] vs. 140 [7.7%]; P <0.001) and coronary intervention (30 [2.2%] vs. 90 [5.0%]; P <0.001) rehospitalizations; CABG patients (n=368) had a lower rate of revascularization (3 [0.8%] vs. 90 [5.0%]; P <0.001), with no difference in rehospitalization rates for E-PCI (n=1014). Among 3282 patients followed 12 months, compared to the PCI cohort (n=1339), MM patients (n=932) had fewer cardiac (155 [16.6%] vs. 323 [24.1%]; P <0.001) and coronary intervention (57 [6.1%] vs. 186 [13.9%]; P <0.001) rehospitalizations; CABG patients (n=265) had less revascularizations (17 [6.4%] vs. 186 [13.9%]; P <0.001) while E-PCI (n=746) had similar rehospitalization rates. Cox regression ( Table 1 ) showed compared to PCI; MM, CABG and E-PCI cohorts had a lower risk of cardiac related rehospitalization ( P <0.05), while MM and CABG cohorts had a lower risk of coronary intervention rehospitalization ( P <0.001). Conclusion: Compared to ACS PCI patients, the adjusted risk for cardiac rehospitalization was lower for MM, CABG and E-PCI cohorts with a lower rate for MM patients while both the risk and rate for coronary intervention rehospitalization were lower for MM and CABG with no differences in the E-PCI cohort. Table 1: Significant Predictors of Rehospitalization Risk (Cox Regression) Risk Of Cardiac Related Rehospitalization Risk of MI Rehospitalization Risk of Coronary Intervention (PCI or CABG) Rehospitalization Variables Hazard Ratio 95% CI Hazard Ratio 95% CI Hazard Ratio 95% CI Medically Managed (Reference: PCI cohort) 0.639 ‡ [0.539,0.756] 0.694 [0.420,1.148] 0.422 ‡ [0.328,0.542] CABG (Reference: PCI cohort) 0.782 * [0.619,0.989] 0.683 [0.343,1.360] 0.420 ‡ [0.284,0.622] Elective PCI (Reference: PCI cohort) 0.811 * [0.687,0.956] 0.870 [0.525,1.441] 0.898 [0.725,1.113] Male Gender 0.922 [0.808,1.052] 1.324 [0.872,2.012] 1.005 [0.834,1.212] 1<CCI<3 ; Reference: CCI<=1 1.270 † [1.072,1.503] 1.369 [0.820,2.284] 1.179 [0.930,1.495] CCI>=3 ; Reference: CCI<=1 1.630 ‡ [1.324,2.007] 2.683 ‡ [1.529,4.708] 1.499 † [1.113,2.019] STEMI 1.255 † [1.078,1.460] 2.225 ‡ [1.482,3.340] 1.197 [0.973,1.473] Prior Diabetes 1.222 * [1.005,1.486] 1.151 [0.658,2.014] 1.173 [0.894,1.539] Prior Hypertension 1.093 [0.947,1.262] 1.706 * [1.106,2.633] 1.127 [0.924,1.375] Baseline Beta-Blocker Use 1.270 ‡ [1.108,1.456] 1.420 [0.953,2.115] 1.187 [0.982,1.435] Baseline Statin Use 0.846 * [0.742,0.964] 0.663 * [0.451,0.973] 0.826 * [0.690,0.990] Baseline Proton Pump Inhibitor Use 0.967 [0.820,1.140] 1.558 * [1.007,2.412] 1.161 [0.931,1.449] Baseline Clopidogrel Use 1.271 † [1.066,1.516] 1.443 [0.861,2.419] 1.146 [0.901,1.459] Baseline Diuretics Use 1.167 * [1.010,1.348] 0.666 [0.430,1.034] 0.975 [0.795,1.195] Baseline Insulin Use 1.325 * [1.066,1.647] 0.949 [0.489,1.844] 1.432 * [1.064,1.927] Baseline Nitroglycerin Use 1.131 [0.956,1.337] 0.770 [0.436,1.360] 1.348 † [1.077,1.686] Baseline Warfarin Use 1.469 † [1.139,1.895] 1.858 [0.926,3.730] 1.023 [0.676,1.547] * P < 0.05, † P < 0.01, ‡ P < 0.001.