Health Disparities| Volume 29, ISSUE 1, P17-22, January 2019

Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome

Published:October 25, 2018DOI:



      It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied.


      Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate.


      A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09–1.60), Medicaid (OR, 1.48; 95% CI, 1.07–2.06), Medicare (1.72; 95% CI, 1.35–2.19), heart failure (1.88; 95% CI, 1.53–2.33), atrial fibrillation (OR, 1.54; 95% CI–1.21–1.95), substance use (OR, 1.88; 95% CI, 1.27–2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29–4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42–2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS.


      Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
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      Luke Lam, MD, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.


      Hyeong Jun Ahn, PhD, is an Assistant Professor and biostatistician at the University of Hawaii Office of Biostatistics and Quantitative Health Sciences.


      Kazue Okajima MD, PhD, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.


      Katie Schoenman, DO, is a senior cardiology fellow at the University of Hawaii Cardiovascular Disease Fellowship Program.


      Todd B. Seto, MD, is an Associate Professor at the University of Hawaii John A. Burns School of Medicine. His research focuses on noninvasive cardiology and outcomes research.


      Ralph V. Shohet, MD, is a Professor of Medicine and Director of the Center for Cardiovascular Research at University of Hawaii John A. Burns School of Medicine. His research focuses on exploring the response of the stressed heart in mouse models.


      Jill Miyamura, PhD, is the Vice President and Senior Research Officer, Hawaii Health Information Corporation.


      Tetine L. Sentell, PhD, is an Associate Professor at the University of Hawaii Office of Public Health Studies. Her research focuses on racial and ethnic disparities in health care access, quality, and outcomes.


      Kazuma Nakagawa, MD, is an Associate Professor of Medicine at the University of Hawaii John A. Burns School of Medicine. He is also the Director of Stroke Center and Medical Director of Obstetric Neurovascular Service at The Queen's Medical Center.