Thirty-Day Readmissions After Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Prospective Single-Center Study from South Punjab, Pakistan

Abstract

Objectives: To determine the rate, underlying causes, and predictors of 30-day readmission among patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) at a tertiary cardiac center in Pakistan. Methodology: This prospective observational study enrolled consecutive adult patients undergoing primary PCI for STEMI. Patients were followed for 30 days post-discharge through electronic medical record review and structured telephone interviews. Readmissions were categorized as cardiac or procedural/vascular causes. Results: Among 250 patients who completed follow-up (mean age 48.7 ± 6.4 years; 68.8% male), 23 patients (9.2%) were readmitted within 30 days. The most frequent cause of readmission was non-ST-segment elevation myocardial infarction (NSTEMI) (30.4%), followed by vascular access complications (17.4%). In-stent thrombosis, unstable angina, and heart failure each accounted for 13.0% of readmissions. On univariable logistic regression analysis, multivessel coronary artery disease was significantly associated with 30-day readmission (OR 3.51; 95% CI 1.43–8.64; p = 0.006). No significant associations were observed for age, sex, diabetes, hypertension, smoking, family history, obesity, access site, or reduced ejection fraction (p > 0.05 for all). Exploratory receiver operating characteristic (ROC) analysis demonstrated modest discrimination for multivessel disease (AUC 0.652; 95% CI 0.534–0.770). Conclusion: Approximately one in ten STEMI patients undergoing primary PCI required readmission within 30 days, predominantly due to recurrent ischemic events and procedural complications. Multivessel disease emerged as a significant predictor of early readmission. Enhanced risk stratification, structured discharge planning, and close post-discharge monitoring may help reduce preventable rehospitalizations in this population.