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April 25, 2012

International Variation in Readmission After Myocardial Infarction

Author Affiliations

Author Affiliation: Gagnon Cardiovascular Institute at Atlantic Health, Morristown, New Jersey (randraws@yahoo.com).

JAMA. 2012;307(16):1690-1691. doi:10.1001/jama.2012.529

To the Editor: Dr Kociol and colleagues1 conducted a retrospective analysis of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. The finding that patients in the United States with ST-elevation myocardial infarction (STEMI) are readmitted more frequently in the short-term compared with their international counterparts is concerning. Three points merit discussion. First, their analysis shows that shorter length of stay is related to more readmissions. The implication is that US patients are being treated suboptimally because they are rushed home by insurers. However, the authors noted that an association between length of stay and readmission has never been proven. In addition, prolonged length of stay would not be useful in uncomplicated, stable patients with STEMI.