SCAD elevates risk for readmission after acute MI, especially in younger women
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Among patients admitted to the hospital with acute MI and spontaneous coronary artery dissection, more than 12% are readmitted within 30 days of discharge, and half of readmissions within 1 week were for cardiac causes.
According to a study published in JACC: Cardiovascular Interventions that assessed 2,654,087 patients admitted to the hospital with acute MI, of whom 1,356 (0.52%) were diagnosed with spontaneous coronary artery dissection (SCAD), there was a higher 30-day readmission rate among patients diagnosed with SCAD compared with propensity score-matched patients without SCAD (12.3% vs. 9.9%; P = .022).
Among patients with SCAD, 80.6% of readmissions were for cardiac causes, with acute MI (44.8%), chest pain (20.1%) and arrhythmia (12.7%) being the most common.
Moreover, 50.6% of readmitted patients with SCAD were readmitted within 1 week after discharge and 54.5% of readmissions for acute MI occurred within 2 days, according to the study.
Among patients with SCAD, 15.5% of those who underwent PCI were readmitted within 30 days compared with 8.7% of those who did not have PCI (P < .0001), according to the researchers.
“To the best of our knowledge, this is the most extensive study evaluating 30-day readmission outcomes in patients diagnosed with SCAD,” Mohamed M. Gad, MD, of the Cleveland Clinic Foundation and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, and colleagues wrote. “Short-term outcomes and 30-day readmission rates differ between patients with and without SCAD, highlighting the potential to improve current management recommendations in patients with SCAD.”
For this study, researchers used the Nationwide Readmissions Database to identify all MI hospital admissions between 2010 and 2015 (mean age, 67 years; 38% women; 36% with diabetes). The propensity-score matched analysis included 1,329 patients with SCAD and 2,642 patients without it.
In the overall cohort before propensity-score matching, patients who were also diagnosed with SCAD were overall younger (mean age, 48 years) and were mostly women (71%) and were less likely to have diabetes than the non-SCAD group (9.6% vs. 36.1%; P < .0001).
“The study by Gad et al would support the empiric recommendation to prolong the index hospitalization of SCAD patients beyond 3 days. Currently, however, identification of patients at higher risk for SCAD extension or recurrences remains elusive,” Fernando Alfonso, MD, PhD, of the department of cardiology at the Hospital Universitario de La Princesa, Spain, and colleagues wrote in a related editorial. “Moreover, we should humbly recognize that, due to the lack of randomized clinical trials, evidence-based treatments to prevent recurrences are lacking. We do not know the best antithrombotic regimen, or whether this should be customized according to clinical presentation (ie, intramural hematoma vs. communicating dissection) or its optimal duration.
“Prospective collaborative research efforts, ideally nationwide or international, are desperately needed to improve the short- and long-term management and, hopefully, the prognosis of SCAD patients,” Alfonso and colleagues wrote. – by Scott Buzby
Disclosures: Gad and the editorial authors report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Alfonso F, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.03.010.
Gad MM, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2019.12.033.
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