The following is a summary of “Incidence, Predictors, and Impact of Hospital Readmission After Revascularization for Left Main Coronary Disease,” published in the March 2024 issue of Cardiology by Kosmidou et al.
The prevalence and correlation between hospital readmissions and post-revascularization outcomes in left main coronary artery disease (LMCAD) remain uncertain.
Researchers conducted a retrospective study to investigate readmissions’ occurrence, determinants, and medical significance after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with LMCAD.
They conducted the EXCEL (XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, involving 1,905 patients diagnosed with LMCAD, randomly assigned to either PCI or CABG. Analyzing the cumulative occurrence of readmissions involved utilizing multivariable Anderson-Gill and joint frailty models to accommodate recurrent events and consider the competing risk of mortality. The influence of readmission on subsequent mortality within a 5-year monitoring period was evaluated through a time-adjusted Cox proportional hazards model.
The result showed that over 5 years, there were 1,868 instances of readmission, involving 851 out of 1,882 (45.2%) individuals who survived hospitalization (with an average of 2.2 readmissions per patient, ranging from 1 to 16). These readmissions were evenly split between cardiovascular and noncardiovascular causes, accounting for approximately half of each (49.6% and 50.4%). Among patients who underwent PCI, 463 out of 942 (48.6%) experienced one or more readmissions, while for those who underwent CABG, the figure was 388 out of 940 (41.8%) (P=0.003). Post multivariable adjustment, PCI emerged as an independent predictor of readmission (adjusted HR: 1.22; 95% CI: 1.10-1.35; P<0.0001), alongside factors such as female sex, comorbidities, and the extent of CAD. Readmission was found to be independently associated with subsequent all-cause mortality. Interaction testing revealed a higher risk of mortality following PCI compared to CABG (adjusted HR: 5.72; 95% CI: 3.42-9.55 vs adjusted HR: 2.72; 95% CI: 1.64-4.88; Pint = 0.03).
EXCEL trial showed higher rates of readmission and increased risk of death following PCI compared to CABG for revascularization of LMCAD over 5 years.