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      Burden of Late Repeat Hospitalization in Patients Undergoing Angioplasty or Bypass Surgery

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          Abstract

          We investigated the incidence and determinants of early and late repeat hospitalization for cardiac causes in 378 patients following myocardial revascularization [199 coronary balloon angioplasty (PTCA), 179 coronary bypass surgery (CABG)] in a single cardiovascular center and followed for a median period of 13 years. Data were available for repeat rehospitalization in 91% and for mortality in all. Patients in the upper quartile for repeat hospitalization (≧4 rehospitalizations) were defined as having multiple repeat hospitalizations. In the PTCA cohort, the rehospitalization rate was high (48%) in the first year, partly due to restenosis and to a group of patients who underwent planned repeat angiography, and then 15–26% annually. In the surgical cohort, annual repeat hospitalization was 8–12% during the first 4 years, but increased to a level similar to that in PTCA patients (19–26%) in the second half of the follow-up period. Independent predictors of multiple (≧4) repeat hospitalizations included systemic hypertension (odds ratio 2.4, 95% CI 1.4–4.0), incomplete revascularization (odds ratio 2.0, 95% CI 1.1–3.4) and less extensive (<3 vessels) disease at the time of the index procedure (odds ratio 2.0, 95% CI 1.1–3.4). Predictors of repeat hospitalization were different from those of mortality (diabetes mellitus, 3-vessel disease). Late repeat hospitalizations after myocardial revascularization impose a considerable burden on the patient and the health care system, and represent an issue which should be better addressed.

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          Predictors of Death and Other Cardiac Events within 2 Years after Coronary Artery Bypass Grafting

          Results: In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG. Conclusion: When using various definitions of a cardiac event after CABG, various risk indicators for death or such an event can be found. Our data suggest that anamnestic information prior to CABG indicating a depressed myocardial function or severe myocardial ischemia are more important predictors of outcome than the information gained from cardioangiography.
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            Author and article information

            Journal
            CRD
            Cardiology
            10.1159/issn.0008-6312
            Cardiology
            S. Karger AG
            0008-6312
            1421-9751
            2002
            September 2002
            26 September 2002
            : 98
            : 1-2
            : 67-74
            Affiliations
            Departments of aCardiology, Cardiovascular Research Unit, and bCommunity Medicine and Epidemiology, Lady Davis Carmel Medical Center and the Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
            Article
            64681 Cardiology 2002;98:67–74
            10.1159/000064681
            12373050
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 4, Tables: 2, References: 15, Pages: 8
            Categories
            Cardiac Catheterization and Interventional Cardiology

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