Incidence, Predictors, and Clinical Impact of Early Readmission After Complex Percutaneous Coronary Intervention.

Abstract

Early (≤30-day) rehospitalization after percutaneous coronary intervention (PCI) is associated with increased morbidity and mortality and is used to measure quality performance. We evaluated the impact and predictors of early readmission following complex PCI using a retrospective analysis of the Mount Sinai Hospital (New York) PCI registry. Associations with 1-year outcomes were evaluated using Cox proportional hazards models with readmission as a time-dependent covariate, and predictors of 30-day readmission were derived using multivariable logistic regression. Between 2012 and 2023, a total of 11,654 patients underwent complex PCI. After excluding staged PCI, 5.8% (n=675) of patients were hospitalized within 30 days post-procedure. Early readmission was associated with significantly worse 1-year outcomes, including higher mortality (4.8% vs. 2.7%, p<0.001). Acute coronary syndrome (ACS), dialysis, multivessel disease, and 3-vessel PCI were independent predictors of early rehospitalization, whereas prior PCI, use of Impella, and femoral access were associated with lower readmission risk. When stratified by sex, ACS was consistently associated with a higher risk of readmission; the protective effect of Impella and the risk associated with multivessel disease and 3-vessel PCI were evident only in men. In conclusion, early rehospitalization after complex PCI is associated with worse 1-year outcomes, and clinical and procedural predictors - including sex-specific differences - should inform risk mitigation strategies to optimize post-PCI care.