sTable 1 International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) Codes and Elixhauser Comorbidity Index (ECI) Used
to Identify the covariates
Covariates Code(s)
Patient Characteristics Female
The patient characteristics are obtained from the variables of NRD directly. Elective STEMI Payer Household income Severity of illness Comorbidities Smoking V15.82, 30.51 (ICD-9-CM) Dyslipidemia 272.0–4 (ICD-9-CM) Hypertension CM_HTN_C (ECI) Diabetes CM_DM、CM_DMCX (ECI)
Obesity CM_OBESE (ECI)
Heart failure CM_CHF (ECI)
Known CAD 414.00–07 (ICD-9-CM)
Prior MI 412 (ICD-9-CM)
Prior PCI V45.82 (ICD-9-CM)
Prior CABG V45.81 (ICD-9-CM)
Carotid artery disease 433.10 (ICD-9-CM) Prior TIA/stroke V12.54, 438.x (ICD-9-CM) Atrial fibrillation 427.31 (ICD-9-CM)
Prior PPM V45.01 (ICD-9-CM)
Prior ICD V45.02 (ICD-9-CM)
Peripheral vascular
disease CM_PERIVASC (ECI)
Anemia CM_ANEMDEF、CM_BLDLOSS (ECI)
Chronic lung disease CM_CHRNLUNG (ECI) Liver disease CM_LIVER (ECI)
Coagulopathy CM_COAG (ECI)
Dementia 290.xx, 294.1x, 294.2x, 294.8, 331.0–2, 331.82, 797 (ICD-9-CM)
Depression CM_DEPRESS (ECI)
Fluid and electrolyte disorders CM_LYTES (ECI) Other neurological disorders CM_NEURO (ECI) Pulmonary circulation disorders CM_PULMCIRC (ECI)
Cancer CM_METS、CM_TUMOR、CM_LYMPH (ECI)
Alcohol misuse CM_ALCOHOL (ECI)
Peptic ulcer disease CM_ULCER (ECI) Valvular heart disease CM_VALVE (ECI) Renal failure CM_RENLFAIL (ECI) Hospital Characteristics
Bed size
The hospital characteristics are obtained from the variables of NRD directly.
Teaching Metropolitan
In-hospital Procedures
Bifurcation 00.44 (ICD-9-CM)
Circulatory support 37.61, 37.68, 39.65 (ICD-9-CM) Vasopressor use 00.17 (ICD-9-CM)
Intra-aortic balloon pump 97.44 (ICD-9-CM) Fractional flow reserve 00.59 (ICD-9-CM) Intravascular ultrasound 00.2x (ICD-9-CM) Drug-eluting stent 36.07 (ICD-9-CM) In-hospital outcomes
Complete heart block 426.0 (ICD-9-CM)
TIA/stroke 431, 433.x1, 434.x1, 435.x, 344.6x, 997.01 (ICD-9-CM) Cardiogenic shock 785.51 (ICD-9-CM)
Major bleeding 430, 431, 432.x, 336, 362.43, 362.81, 363.61,363.62, 363.72, 364.41, 3736.32, 377.42, 379.23; 423.0 + 37.0; 923.x + 729.71, 924.x + 729.72, 922.2–9 + 729.73; 456.0, 456.20, 530.7, 530.82, 531.00, 531.01, 531.20, 531.21, 531.40, 531.41, 531.60, 531.61,532.00, 532.01, 532.20, 532.21, 532.40, 532.41,532.60, 532.61, 533.00, 533.01, 533.20, 533.21,533.40, 533.41, 533.60, 533.61, 534.00, 534.01,534.20, 534.21, 534.40, 534.41, 534.60, 534.61,569.3, 578.0, 578.1, 578.9, 568.81, 599.70, 599.71,719.1x, 784.7, 784.8, 459, 998.11, 998.12, 285.1 + 998.00, 998.09, 785.50, 785.59, 276.52 + 00.17 + 99.0x (ICD-9-CM)
Blood transfusion 99.02,99.04 (ICD-9-CM)
Vascular complication 900–904, 998.2, 999.2, 997.7, 447.0, 868.04 + 39.31, 39.41, 39.49, 39.52, 39.56, 39.57, 39.59, 39.79
sTable 2 Comorbidities, hospital characteristics, in-hospital procedures, and in-hospital outcomes
All
(n=492 550)
Age group (Years)
P value
18~54 (n=126 895) 55~64 (n=140 994) 65~74 (n=119 923) 75~ (n=104 738) Comorbidities Smoking 48.25 62.56 53.64 43.07 29.56 <0.0001 Dyslipidemia 69.78 66.33 70.36 72.47 70.13 <0.0001 Hypertension 71.66 62.57 70.18 75.83 79.92 <0.0001 Diabetes 33.71 28.84 33.44 38.42 34.56 <0.0001 Obesity 17.58 22.73 19.58 17.30 8.98 <0.0001 Heart failure 0.41 0.17 0.35 0.49 0.69 <0.0001 Known CAD 90.19 88.39 90.08 91.02 91.56 <0.0001 Prior MI 11.18 9.37 10.90 12.21 12.56 <0.0001 Prior PCI 16.29 12.58 15.94 18.53 18.68 <0.0001 Prior CABG 5.28 2.09 4.30 7.06 8.41 <0.0001Carotid artery disease 1.58 0.35 1.03 2.20 3.07 <0.0001
Prior TIA/stroke 6.42 2.95 5.04 7.65 11.06 <0.0001
Atrial fibrillation 10.92 3.01 6.78 13.19 23.47 <0.0001
Prior PPM 1.67 0.25 0.55 1.64 4.94 <0.0001
Prior ICD 1.25 0.74 1.11 1.58 1.65 <0.0001
All
(n=492 550)Age group (Years)
P value
18~54 (n=126 895) 55~64 (n=140 994) 65~74 (n=119 923) 75~ (n=104 738) Anemia 10.74 5.61 7.66 12.16 19.46 <0.0001Chronic lung disease 16.47 10.90 15.73 20.27 19.87 <0.0001
Liver disease 1.24 1.30 1.67 1.22 0.60 <0.0001
Coagulopathy 3.05 1.76 2.69 3.51 4.57 <0.0001
Dementia 2.09 0.04 0.29 1.43 7.77 <0.0001
Depression 7.02 6.94 7.45 7.20 6.32 <0.0001
Hypothyroidism 9.00 4.15 6.62 10.48 16.38 <0.0001
Fluid and electrolyte disorders 15.28 12.65 13.88 15.99 19.53 <0.0001
Other neurological disorders 3.84 2.53 3.00 4.01 6.36 <0.0001
Pulmonary circulation disorders 0.06 0.02 0.04 0.09 0.09 <0.0001
Cancer 1.91 0.70 1.52 2.58 3.13 <0.0001
Alcohol misuse 3.29 5.04 4.15 2.43 0.98 <0.0001
Peptic ulcer disease 0.02 0.01 0.01 0.03 0.02 0.0003
Valvular heart disease 0.11 0.03 0.09 0.12 0.21 <0.0001
Renal failure 12.82 5.07 8.60 15.23 25.15 <0.0001
Hospital Characteristics
Bed size 0.0008
All
(n=492 550)Age group (Years)
P value
18~54 (n=126 895) 55~64 (n=140 994) 65~74 (n=119 923) 75~ (n=104 738) Medium 24.63 25.00 24.84 24.21 24.39 Large 67.17 66.79 66.96 67.53 67.47 Teaching <0.0001 Non-teaching 40.64 39.77 39.87 41.41 41.86 Teaching 59.36 60.23 60.13 58.59 58.14 Metropolitan 0.0027 Non-metropolitan 6.23 6.03 6.26 6.37 6.29 Metropolitan 93.77 93.97 93.74 93.63 93.71 In-hospital Procedures Bifurcation 2.82 2.73 2.92 2.74 2.92 0.0886 Circulatory support 4.03 3.43 4.03 4.35 4.39 <0.0001 Vasopressor use 0.81 0.67 0.83 0.79 0.99 <0.0001Intra-aortic balloon pump 0.79 0.67 0.82 0.80 0.87 <0.0001
Fractional flow reserve 1.65 1.45 1.67 1.81 1.68 <0.0001
Intravascular ultrasound 5.01 5.16 4.80 5.18 4.91 0.2426
Drug-eluting stent 74.84 74.86 76.35 76.95 70.36 <0.0001
All
(n=492 550)Age group (Years)
P value
18~54 (n=126 895) 55~64 (n=140 994) 65~74 (n=119 923) 75~ (n=104 738)Complete heart block 1.28 0.83 1.20 1.42 1.76 <0.0001
TIA/stroke 0.93 0.57 0.72 1.06 1.50 <0.0001
Cardiogenic shock 4.45 3.44 4.40 4.92 5.18 <0.0001
Cardiac arrest 2.67 2.93 2.93 2.52 2.19 <0.0001
Acute kidney injury 8.58 4.49 6.52 9.86 14.84 <0.0001
Major bleeding 6.28 3.99 5.20 6.91 9.80 <0.0001
Blood transfusion 2.59 1.14 1.78 3.05 4.90 <0.0001
Vascular complication 0.57 0.47 0.51 0.61 0.71 <0.0001
All values are percentage (%).
sTable 3 The sensitivity analyses of missing data for 30-day readmission according to the age group
Outcomes Age group (Years)
18~54 55-64 65-74 75~ All cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.05(1.01-1.11) 1(ref) 0.93(0.88-0.99) 1.01(0.95-1.08)
P Value 0.0286 0.0174 0.6553
Noncardiac cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.05(0.99-1.13) 1(ref) 0.94(0.87-1.01) 0.97(0.90-1.06)
P Value 0.1085 0.1060 0.5276
Infection
Adjusted OR (95% CI) 1.14(0.94-1.38) 1(ref) 1.21(1.00-1.47) 1.40(1.13-1.73)
P Value 0.1723 0.0562 0.0018
Non-specific chest pain
Adjusted OR (95% CI) 1.45(1.26-1.67) 1(ref) 0.69(0.57-0.84) 0.66(0.52-0.83)
P Value <0.0001 0.0002 0.0003
Gastrointestinal
Adjusted OR (95% CI) 0.95(0.78-1.16) 1(ref) 0.98(0.80-1.22) 1.03(0.81-1.30)
P Value 0.6088 0.8865 0.8065
Cardiac cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.04(0.97-1.11) 1(ref) 0.94(0.88-1.01) 1.07(0.99-1.16)
P Value 0.2357 0.1161 0.0803
Heart failure
Adjusted OR (95% CI) 1.04(0.97-1.11) 1(ref) 0.94(0.88-1.01) 1.07(0.99-1.16)
P Value 0.2357 0.1161 0.0803
Coronary artery disease including angina
Adjusted OR (95% CI) 1.16(1.05-1.30) 1(ref) 0.77(0.67-0.89) 0.72(0.61-0.84)
P Value 0.0055 0.0004 <0.0001
Acute myocardial infarction
Adjusted OR (95% CI) 1.12(0.99-1.28) 1(ref) 0.97(0.84-1.13) 0.99(0.84-1.15)
P Value 0.0748 0.7327 0.8528
sTable 4 The sensitivity analyses of excluding patients whose transfers or discharges were the same day for 30-day readmission according to the age group
Outcomes Age group (Years)
18~54 55-64 65-74 75~ All cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.06(1.01-1.11) 1(ref) 0.94(0.89-0.99) 1.02(0.96-1.09)
P Value 0.0161 0.0326 0.5408
Noncardiac cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.06(0.99-1.13) 1(ref) 0.95(0.88-1.02) 0.98(0.90-1.06)
P Value 0.0947 0.1721 0.6260
Infection
Adjusted OR (95% CI) 1.14(0.93-1.38) 1(ref) 1.24(1.02-1.51) 1.44(1.16-1.79)
P Value 0.1996 0.0340 0.0009
Non-specific chest pain
Adjusted OR (95% CI) 1.44(1.25-1.67) 1(ref) 0.69(0.56-0.84) 0.66(0.52-0.83)
P Value <0.0001 0.0002 0.0005
Gastrointestinal
Adjusted OR (95% CI) 0.96(0.79-1.17) 1(ref) 0.98(0.80-1.22) 1.00(0.79-1.27)
P Value 0.7032 0.8864 0.9807
Cardiac cause, 30-day, unplanned readmission
Adjusted OR (95% CI) 1.05(0.98-1.12) 1(ref) 0.95(0.88-1.02) 1.08(0.99-1.17)
P Value 0.1644 0.1412 0.0689
Heart failure
Adjusted OR (95% CI) 0.79(0.67-0.94) 1(ref) 1.08(0.93-1.25) 1.49(1.28-1.73)
P Value 0.0073 0.3328 <0.0001
Coronary artery disease including angina
Adjusted OR (95% CI) 1.18(1.06-1.32) 1(ref) 0.77(0.67-0.89) 0.71(0.60-0.83)
P Value 0.0027 0.0005 <0.0001
Acute myocardial infarction
Adjusted OR (95% CI) 1.14(1.00-1.30) 1(ref) 0.97(0.83-1.13) 1.00(0.85-1.18)
P Value 0.0501 0.6767 0.9975
sTable 5 Early 30 day readmission across 4 age groups (<15 days vs. >15 days)
All (n=48 630)
Age group (Years)
P value 18~54 (n=9 228) (n=11 247) 55~64 (n=12 650) 65~74 (n=15 506) 75~ Days of readmission (%) ≤15 days 71.52 71.64 71.21 71.71 71.53 0.8918 >15 days 28.48 28.36 28.79 28.29 28.47
sTable 6 The interaction test between interaction terms and age groups
Outcome Effect F value P value for interaction
For “SEX”
All cause, 30-day, unplanned readmission
Sex*Age group 5.49 0.0009 Age group 4.55 0.0035
Sex 48.41 <0.0001
Noncardiac cause, 30-day, unplanned readmission
Sex*Age group 8.57 <0.0001 Age group 1.56 0.1972
Sex 42.12 <0.0001
Cardiac cause, 30-day, unplanned readmission
Sex*Age group 0.20 0.8971 Age group 3.68 0.0117
Sex 11.24 0.0008
For “Type of AMI”
All cause, 30-day, unplanned readmission
Type of AMI *Age group 1.94 0.1209 Age group 2.68 0.0454 Type of AMI 4.24 0.0397 Noncardiac cause, 30-day, unplanned readmission
Type of AMI *Age group 0.49 0.6914 Age group 0.78 0.5063 Type of AMI 0.47 0.4911 Cardiac cause, 30-day, unplanned readmission
Type of AMI *Age group 2.38 0.0684 Age group 2.67 0.0461 Type of AMI 15.28 <0.0001
sTable 7 The parameter estimates of interaction terms
Outcome Term Age group Subgroup factor
β value P value
For “SEX”
All cause, 30-day, unplanned readmission - -
reference 55~64 male
interaction term 1 18~54 female 0.0869 0.0958 interaction term 2 65~74 female -0.0527 0.2580 interaction term 3 75~ female -0.1154 0.0210 Noncardiac cause, 30-day, unplanned readmission
reference 55~64 male - - interaction term 1 18~54 female 0.1290 0.0781 interaction term 2 65~74 female -0.0942 0.1287 interaction term 3 75~ female -0.2006 0.0014 Cardiac cause, 30-day, unplanned readmission
reference 55~64 male - - interaction term 1 18~54 female 0.0359 0.6198 interaction term 2 65~74 female -0.0068 0.9194 interaction term 3 75~ female -0.0129 0.8524
For “Type of AMI”
All cause, 30-day, unplanned readmission
reference 55~64 NSTEMI - - interaction term 1 18~54 STEMI -0.0759 0.1581 interaction term 2 65~74 STEMI -0.0326 0.4841 interaction term 3 75~ STEMI 0.0384 0.4385 Noncardiac cause, 30-day, unplanned readmission
reference 55~64 NSTEMI - - interaction term 1 18~54 STEMI 0.00672 0.9252 interaction term 2 65~74 STEMI -0.00611 0.9221 interaction term 3 75~ STEMI 0.0624 0.3237 Cardiac cause, 30-day, unplanned readmission
sTable 8 The sensitivity analyses of adding each part of covariates in model for the association between age and all-cause readmission
Covariates in model Age group (Years)
18~54 55~64 65~74 75~
Patient Characteristics 0.99(0.94-1.03) ref 0.93(0.88-0.99) 1.14(1.07-1.21)
0.5369 0.0180 <0.0001
Patient Characteristics+
Hospital Characteristics 0.99(0.94-1.03) 0.5362 ref 0.93(0.88-0.99) 0.0169 1.14(1.07-1.20) <0.0001 Patient Characteristics+ Hospital Characteristics+ Comorbidities 1.06(1.01-1.11) ref 0.94(0.89-1.00) 1.07(1.01-1.14) 0.0193 0.0436 0.0215 Patient Characteristics+ Hospital Characteristics+ Comorbidities+ In-hospital outcomes 1.07(1.02-1.12) ref 0.94(0.89-0.99) 1.02(0.96-1.09) 0.0100 0.0241 0.5260 Patient Characteristics+ Hospital Characteristics+ Comorbidities+ In-hospital outcomes+ In-hospital Procedures 1.06(1.01-1.11) ref 0.94(0.89-1.00) 1.02(0.96-1.09) 0.0129 0.0377 0.5175 Patient Characteristics+ Hospital Characteristics+ In-hospital outcomes 1.00(0.96-1.05) ref 0.92(0.87-0.98) 1.04(0.98-1.11) 0.9363 0.0052 0.2064 Patient Characteristics+ Hospital Characteristics+ In-hospital Procedures 0.98(0.94-1.03) ref 0.94(0.89-1.00) 1.13(1.06-1.20) 0.4956 0.0334 <0.0001
Remove “Severity of illness” from model
Patient Characteristics 0.93(0.89-0.98) ref 0.92(0.86-0.97) 1.24(1.17-1.32)