Early readmissions after percutaneous mechanical circulatory support-assisted percutaneous coronary intervention: Insights from the nationwide readmissions database.

Background: The use of percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) has seen an increase in use over the past five years. It remains unclear how the increased prevalence has affected the rate of readmissions and what clinical predictors may play a role in a patient's readmission. We aimed to assess the cardiovascular causes, mortality rate, and clinical predictors of patients readmitted after experiencing pMCS-assisted PCI.

Methods: Patients who underwent pMCS (intra-aortic balloon pump, Impella, or percutaneous left ventricular assist device) and PCI between January 2016 and November 2020 were selected from the nationwide readmission database. The frequency and underlying causes of cardiovascular-related 30-day readmissions were assessed, as delineated by the International Classification of Diseases, Tenth Revision (ICD-10) codes. Additionally, readmission mortality rates, mean hospital stay length, cumulative hospital charges, and independent factors predictive of 30-day all-cause readmissions were analyzed. A secondary analysis of mortality and readmission rate in patients with cardiogenic shock who underwent pMCS were compared to those with pMCS-assisted PCI.

Results: Of the 77,099 patients discharged alive after receiving pMCS-assisted PCI, 12,072 (15.6%) had a readmission within 30 days. Among the readmissions, the all-cause mortality was 876 (7.26%). The most common cardiovascular causes for readmission were hypertensive heart disease with heart failure (8.6%), hypertensive heart and chronic kidney disease stage 1-4 (8.3%), and non-ST elevation myocardial infarction (4.1 %). Readmitted patients exhibited a shorter mean length of stay in contrast to their index admission (5.9 vs 9.9 days, p < 0.0001). Patients who were readmitted incurred total hospital charges of $1.01 billion US. Factors independently associated with 30-day readmissions were female sex, leaving against medical advice, renal insufficiency, congestive heart failure, prior valve replacement, and length of stay > 10 days. Index mortality was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (32.6% vs 26.4%; CI: 5.8-6.6, p < 0.001). Readmission rate was significantly higher in the pMCS-assisted cardiogenic shock cohort compared the pMCS-assisted PCI group (16.4% vs 15.7 %; CI: 0.4-1.1, p < 0.001).

Conclusion: Our study revealed that 15.6% of patients discharged after receiving pMCS-assisted PCI were readmitted within 30 days, with an all-cause mortality rate of 7.26% among these readmissions. The most common causes of readmission were related to hypertensive heart disease and NSTEMI. These findings underscore the need for targeted interventions to reduce readmissions and associated healthcare costs, as well as the importance of identifying high-risk patients for more intensive follow-up and management after discharge from pMCS-assisted PCI.