Spontaneous coronary artery dissection (SCAD) is a frequently missed diagnosis in
patients presenting with acute coronary syndrome (ACS). Our aim was to evaluate the
causes, trends, and predictors of 90-day hospital readmission in patients presenting
with SCAD. The Nationwide Readmissions Database (2013 to 2014) was utilized to identify
patients with primary discharge diagnosis of SCAD using the International Classification
of Diseases, Ninth Revision, Clinical Modification, diagnostic code 414.12. The primary
outcome was 90-day readmission. Among 11,228 patients admitted with the primary diagnosis
of SCAD, 2,424 patients (21.6%) were readmitted within 90 days (68% women, 82% <65
years of age). Common causes for 90-day readmission were ACS (25%), acute heart failure
(11%), acute respiratory failure (7%), and arrhythmias (5%). Multivariate predictors
of 90-day readmissions were hypertension, chronic obstructive pulmonary disease, peripheral
arterial disease, discharge to facility and increased length of stay (LOS) during
index admission. Multivariate predictors of increased healthcare-related costs were
older age, female gender, discharge to facility, and increased LOS. Over half of the
readmissions (52%) occurred in first 30 days after discharge. In conclusion, we found
a high rate of rehospitalization among SCAD patients, particularly within the first
30 days of index hospitalization. ACS, heart failure, and acute respiratory failure
were the most common reasons for readmission. Hypertension, chronic obstructive pulmonary
disease, peripheral arterial disease, and increased LOS were independent predictors
of readmission. Further studies are warranted to confirm these predictors of readmission
in this high-risk population.
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Article info
Publication history
Published online: August 09, 2019
Received in revised form:
July 21,
2019
Received:
June 6,
2019
Footnotes
Funding Sources: No study specific funding was used to support this work manuscript.
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© 2019 Elsevier Inc. All rights reserved.
