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Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction

View Article: PubMed Central - PubMed

ABSTRACT

Background: Rehospitalizations following acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are often included as parts of composite end points in clinical trials. Although clearly costly, the clinical relevance of these individual components has not been described.

Methods and results: Patients enrolled in a prospective, 24‐center, US acute myocardial infarction registry were followed for 1 year after an acute myocardial infarction for rehospitalizations, that were independently adjudicated by experienced cardiologists. Patients who did and did not experience UA or revascularization rehospitalization were propensity matched using greedy matching. Among 3283 patients with acute myocardial infarction who were included, mean age was 59 years, 33% were female, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 5.0% and 4.1%, respectively. After propensity matching, we included 2433 patients in the UA rehospitalization group and 2410 in the unplanned revascularization group. Using weighted proportional hazards Cox regression, there was no significant association between a rehospitalization for UA and 5‐year all‐cause mortality (9.6% versus 13.8%; adjusted hazard ratio 0.87, 95% CI 0.60–1.16). Patients rehospitalized for unplanned revascularization had a lower 5‐year mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50–0.92) compared with those without such rehospitalizations. Nevertheless, patients with UA and unplanned revascularization had a substantially greater hazard of subsequent rehospitalizations compared with patients without such events (UA: hazard ratio 4.36, 95% CI 3.48–5.47; revascularization: hazard ratio 4.38, 95% CI 3.53–5.44).

Conclusions: Rehospitalizations for UA and unplanned revascularization in the year after an acute myocardial infarction are associated with higher risks of subsequent rehospitalizations but not with mortality.

No MeSH data available.


Related in: MedlinePlus

Assessment of balance before and after propensity matching between patients with and without unstable angina rehospitalizations (A) and unplanned coronary revascularization rehospitalizations (B). ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ArrKillip, Killip class on arrival; BL, baseline; BMI, body mass index; BP, blood pressure; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CVA, cerebrovascular accident; DC, discharge; GRACE, Global Registry of Acute Coronary Event; LV, left ventricular; max, maximum; MI, myocardial infarction; Mo, month; PCI, percutaneous coronary intervention; Pt, patient; ReqRx, requiring treatment; SAQ, Seattle Angina Questionnaire; SF‐12, Short Form 12; TIA, transient ischemic attack.
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jah31686-fig-0002: Assessment of balance before and after propensity matching between patients with and without unstable angina rehospitalizations (A) and unplanned coronary revascularization rehospitalizations (B). ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ArrKillip, Killip class on arrival; BL, baseline; BMI, body mass index; BP, blood pressure; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CVA, cerebrovascular accident; DC, discharge; GRACE, Global Registry of Acute Coronary Event; LV, left ventricular; max, maximum; MI, myocardial infarction; Mo, month; PCI, percutaneous coronary intervention; Pt, patient; ReqRx, requiring treatment; SAQ, Seattle Angina Questionnaire; SF‐12, Short Form 12; TIA, transient ischemic attack.

Mentions: Among 3283 patients who were followed for 1 year after AMI, 140 patients (Kaplan–Meier estimate of 5.0%) were rehospitalized due to UA, with a median time to event of 4.1 months (interquartile range 1.2–7.3 months), and 113 patients (Kaplan–Meier estimate of 4.1%) were rehospitalized for unplanned coronary revascularizations, with a median time to event of 3.6 months (interquartile range 1.5–7.4 months). There were 56 patients who were admitted with both of these events and thus were included in both cohorts. The propensity‐matched cohorts for UA and unplanned coronary revascularization included 2433 and 2410 patients, respectively. There were no significant differences between the matched cohorts for either UA or revascularization, as suggested by small standardized differences between the groups (Table 2). Figure 2A shows the balance between patients with and without UA rehospitalization, and Figure 2B shows the balance between patients with and without unplanned coronary revascularization before and after propensity score matching.


Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction
Assessment of balance before and after propensity matching between patients with and without unstable angina rehospitalizations (A) and unplanned coronary revascularization rehospitalizations (B). ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ArrKillip, Killip class on arrival; BL, baseline; BMI, body mass index; BP, blood pressure; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CVA, cerebrovascular accident; DC, discharge; GRACE, Global Registry of Acute Coronary Event; LV, left ventricular; max, maximum; MI, myocardial infarction; Mo, month; PCI, percutaneous coronary intervention; Pt, patient; ReqRx, requiring treatment; SAQ, Seattle Angina Questionnaire; SF‐12, Short Form 12; TIA, transient ischemic attack.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5015270&req=5

jah31686-fig-0002: Assessment of balance before and after propensity matching between patients with and without unstable angina rehospitalizations (A) and unplanned coronary revascularization rehospitalizations (B). ACEI indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ArrKillip, Killip class on arrival; BL, baseline; BMI, body mass index; BP, blood pressure; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CVA, cerebrovascular accident; DC, discharge; GRACE, Global Registry of Acute Coronary Event; LV, left ventricular; max, maximum; MI, myocardial infarction; Mo, month; PCI, percutaneous coronary intervention; Pt, patient; ReqRx, requiring treatment; SAQ, Seattle Angina Questionnaire; SF‐12, Short Form 12; TIA, transient ischemic attack.
Mentions: Among 3283 patients who were followed for 1 year after AMI, 140 patients (Kaplan–Meier estimate of 5.0%) were rehospitalized due to UA, with a median time to event of 4.1 months (interquartile range 1.2–7.3 months), and 113 patients (Kaplan–Meier estimate of 4.1%) were rehospitalized for unplanned coronary revascularizations, with a median time to event of 3.6 months (interquartile range 1.5–7.4 months). There were 56 patients who were admitted with both of these events and thus were included in both cohorts. The propensity‐matched cohorts for UA and unplanned coronary revascularization included 2433 and 2410 patients, respectively. There were no significant differences between the matched cohorts for either UA or revascularization, as suggested by small standardized differences between the groups (Table 2). Figure 2A shows the balance between patients with and without UA rehospitalization, and Figure 2B shows the balance between patients with and without unplanned coronary revascularization before and after propensity score matching.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Rehospitalizations following acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are often included as parts of composite end points in clinical trials. Although clearly costly, the clinical relevance of these individual components has not been described.

Methods and results: Patients enrolled in a prospective, 24‐center, US acute myocardial infarction registry were followed for 1 year after an acute myocardial infarction for rehospitalizations, that were independently adjudicated by experienced cardiologists. Patients who did and did not experience UA or revascularization rehospitalization were propensity matched using greedy matching. Among 3283 patients with acute myocardial infarction who were included, mean age was 59 years, 33% were female, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 5.0% and 4.1%, respectively. After propensity matching, we included 2433 patients in the UA rehospitalization group and 2410 in the unplanned revascularization group. Using weighted proportional hazards Cox regression, there was no significant association between a rehospitalization for UA and 5‐year all‐cause mortality (9.6% versus 13.8%; adjusted hazard ratio 0.87, 95% CI 0.60–1.16). Patients rehospitalized for unplanned revascularization had a lower 5‐year mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50–0.92) compared with those without such rehospitalizations. Nevertheless, patients with UA and unplanned revascularization had a substantially greater hazard of subsequent rehospitalizations compared with patients without such events (UA: hazard ratio 4.36, 95% CI 3.48–5.47; revascularization: hazard ratio 4.38, 95% CI 3.53–5.44).

Conclusions: Rehospitalizations for UA and unplanned revascularization in the year after an acute myocardial infarction are associated with higher risks of subsequent rehospitalizations but not with mortality.

No MeSH data available.


Related in: MedlinePlus