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CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS IS ASSOCIATED WITH MORE 30-DAY HOSPITAL READMISSIONS
278 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS IS ASSOCIATED WITH MORE 30-DAY HOSPITAL READMISSIONS Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 1222-113 Authors: Jessica Parsh, Milan Seth, David Miller, John Syrjamaki, Hitinder Gurm, University of Michigan Health System, Ann Arbor, MI, USA
Background: Contrast-induced acute kidney injury (CI-AKI) in the setting of percutaneous coronary interventions (PCI) is associated with increased morbidity and mortality, however its association with the quality metric of 30-day hospital readmission rate is unknown. Methods: Data from the Blue Cross Blue Shield of Michigan Cardiovascular Collaborative (BMC2) was supplemented by administrative claims from the Michigan Value Collaborative for commercially insured patients undergoing PCI at 31 hospitals between 1/1/2010 and 12/31/2014. CI-AKI was defined as an increase in serum creatinine of 0.5 mg/dl or greater after PCI, and 30-day readmission was determined from claims.
Results: A total of 8,524 PCIs were performed, the majority for acute coronary syndromes (33% STEMI, 31% NSTEMI, 28% unstable angina). We excluded 68 patients on dialysis at the time of PCI and 805 missing pre or post PCI creatinine values. Of the remaining 7,651 cases, 125 (1.63%) met criteria for CI-AKI. The 30-day readmission rate for CI-AKI patients was 17.6%, compared to 6.8% for patients without CI-AKI (p < .001, OR = 2.94). The most common primary diagnosis for readmissions among patients with CI-AKI was heart failure (HF) with or without complications, while patients without CI-AKI were most commonly readmitted for repeat PCI. Readmitted patients with CI-AKI were more likely to have a history of HF prior to PCI (31.8%) compared to readmissions without CI-AKI (9.6%). However, after excluding cases with a history of HF, 30-day readmission with a HF diagnosis remained significantly greater for CI-AKI patients (5.8% vs .18%, p < .0001).
Conclusions: Our study demonstrates an association between CI-AKI and increased 30-day hospital readmission, with heart failure documented as the most common etiology for readmission among these patients. Further research in treatment and preventative strategies of CI-AKI is warranted with the goal of reducing morbidity and mortality as well as the financial cost associated with hospital readmissions.
ACC.i2 Interventional Cardiology CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTIONS IS ASSOCIATED WITH MORE 30-DAY HOSPITAL READMISSIONS Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 1222-113 Authors: Jessica Parsh, Milan Seth, David Miller, John Syrjamaki, Hitinder Gurm, University of Michigan Health System, Ann Arbor, MI, USA
Background: Contrast-induced acute kidney injury (CI-AKI) in the setting of percutaneous coronary interventions (PCI) is associated with increased morbidity and mortality, however its association with the quality metric of 30-day hospital readmission rate is unknown. Methods: Data from the Blue Cross Blue Shield of Michigan Cardiovascular Collaborative (BMC2) was supplemented by administrative claims from the Michigan Value Collaborative for commercially insured patients undergoing PCI at 31 hospitals between 1/1/2010 and 12/31/2014. CI-AKI was defined as an increase in serum creatinine of 0.5 mg/dl or greater after PCI, and 30-day readmission was determined from claims.
Results: A total of 8,524 PCIs were performed, the majority for acute coronary syndromes (33% STEMI, 31% NSTEMI, 28% unstable angina). We excluded 68 patients on dialysis at the time of PCI and 805 missing pre or post PCI creatinine values. Of the remaining 7,651 cases, 125 (1.63%) met criteria for CI-AKI. The 30-day readmission rate for CI-AKI patients was 17.6%, compared to 6.8% for patients without CI-AKI (p < .001, OR = 2.94). The most common primary diagnosis for readmissions among patients with CI-AKI was heart failure (HF) with or without complications, while patients without CI-AKI were most commonly readmitted for repeat PCI. Readmitted patients with CI-AKI were more likely to have a history of HF prior to PCI (31.8%) compared to readmissions without CI-AKI (9.6%). However, after excluding cases with a history of HF, 30-day readmission with a HF diagnosis remained significantly greater for CI-AKI patients (5.8% vs .18%, p < .0001).
Conclusions: Our study demonstrates an association between CI-AKI and increased 30-day hospital readmission, with heart failure documented as the most common etiology for readmission among these patients. Further research in treatment and preventative strategies of CI-AKI is warranted with the goal of reducing morbidity and mortality as well as the financial cost associated with hospital readmissions.