Low-risk chest pain may account for most PCI readmissions

Readmission after PCI is common, and a study published online online Jan. 14 in Circulation: Cardiovascular Interventions found that PCI readmissions were most often due to recurrent chest pain or angina symptoms that were typically not caused by a heart attack. Instead, the symptoms were often related to diagnostic studies or procedures.

Jason H. Wasfy, MD, MPhil, of Harvard Medical School in Boston, and colleagues evaluated medical records from patients who underwent PCI at Brigham and Women’s Hospital in Boston from June 2009 and December 2011 and at Massachusetts General Hospital between January 2007 and December 2011. They determined which patients were readmitted to the index hospital within 30 days of discharge.

There were 9,288 PCIs at both hospitals during the evaluation periods. Of these patients, 9.8 percent were readmitted within 30 days and included in the study analysis. Most of the readmitted patients (38.1 percent) went back in the hospital for recurrent chest pain or angina symptoms. Other reasons for readmission included staged PCI with no new symptoms (6.6 percent) and complications of PCI (6.7 percent).

Among patients with chest pain or angina symptoms, 6.2 percent had an MI and 15.8 percent underwent another PCI. Most patients with chest pain had one or more diagnostic imaging tests, and coronary angiography was the most common test. Only 2.6 percent of patients readmitted with chest pain required repeat revascularization.

The authors acknowledged that among their study’s limitations was the lack of generalizability to patients outside the health network where the research took place, but they argued their findings suggest an area of considerable cost savings.

“Reducing admissions for low-risk chest pain after PCI has the potential to save substantial healthcare costs,” they wrote. “The effects of those changes on safety and patient satisfaction deserve further investigation.”