Differences in risk factors and resource utilization for women undergoing percutaneous coronary intervention and lower extremity peripheral vascular intervention.

OBJECTIVE: To investigate the differences in risk factors and in-hospital outcomes for women undergoing percutaneous coronary intervention (PCI) and peripheral vascular intervention (PVI). BACKGROUND: The clinical impact of coronary artery disease (CAD) and peripheral artery disease (PAD) is well characterized and is associated with high morbidity and mortality. There is lack of data comparing risk factors and in-hospital outcomes for PCI and PVI, particularly in women. METHODS: Only female hospitalizations (age ≥ 18 years) who underwent PCI or PVI from 2005 to 2014 were identified using appropriate International Classification of Diseases-Ninth Revision, Clinical Modification codes from the National Inpatient Sample database. Charlson's Comorbidity Index (CCI) was selected as the primary endpoint of the study. Coprimary endpoint was the cost of hospitalizations associated with PCI or PVI. RESULTS: Of the 2,461,328 female hospitalizations that were included, 85.6% (N = 2,105,236) underwent PCI and 14.4% (N = 356,092) received PVI. Compared to PCI, PVI hospitalizations were 3.2 years older (p < .001) and consisted of significantly more hospitalizations above 80 years of age (26.5% vs. 18.6%; p < .001). Hospitalizations with CCI ≥3 were significantly higher in the PVI cohort (29.1% vs. 24%; p < .001). CCI in women increased during the study period for both groups. PVI hospitalizations had a significantly longer length of stay (3 days vs. 2 days; p < .001) and cost of hospitalization ($23,610 vs. $20,571; p < .001), compared to PCI. Finally, the mean cost of hospitalizations increased during the study period for PCI and PVI. CONCLUSION: Women hospitalized for PVI had a greater risk-profile and resource utilization as demonstrated by the longer length of stay and higher cost compared to PCI.

Comparison of Baseline Characteristics and In-hospital Outcomes in Medicaid Versus Private Insurance Hospitalizations for Atrial Fibrillation.

The prevalence of atrial fibrillation (Afib) has been increasing over the past few decades. There are very few comparisons of health insurance plans available that incorporate measurement of co-morbidities and in-hospital outcomes. We sought to compare an impact of Medicaid versus private insurance (PI) on outcomes in hospitalizations with Afib. The US National Inpatient Sample database from years January 2010 to September 2015 was used to identify adult (≥18 years) Afib hospitalizations, whose payment source was either Medicaid or PI. We included propensity score-matched analysis for comparison of outcomes between the groups. In a total of 3,264,258 Afib hospitalizations, 22.9% hospitalizations were insured with Medicaid, while 77.1% had PI. Compared with PI, Medicaid beneficiaries (MB) were younger (59 vs 64 years), fewer were men (55.15% vs 63.16%), and fewer were Caucasians (52.66% vs 81.67%; all p<0.0001). As suggested by Charlson co-morbidity index ≥3, more MB (40.86%) had the significantly higher burden of co-morbidities compared with PI (29.87%; p<0.0001). About 83% of Afib hospitalizations had a CHA2DVASC2 score ≥2 in both the groups. After adjusting for confounders, in-hospital mortality was significantly higher (4.8% vs 4.3%, p = 0.02) in MB compared with PI. In MB, 55.3% hospitalizations were discharged to home and their median length of hospital stay was 5 days, whereas 61.3% hospitalizations with PI were discharged to home and their median length of stay was 4 days (p<0.0001). In conclusion, this extensive study of Afib hospitalizations, Medicaid group had greater co-morbidities, marginally higher in-hospital mortality, longer length of stay, and lesser disposition to home as compared with PI group.

Clinical Outcomes of Atherectomy Prior to Percutaneous Coronary Intervention: A Comparative Assessment of Atherectomy in Patients With Obesity (COAP-PCI Subanalysis).

OBJECTIVES: The aim of this study was to investigate the safety and efficacy of atherectomy devices in obese patients with coronary artery calcification (CAC). BACKGROUND: Atherectomy is an important tool for lesion preparation in patients with CAC undergoing percutaneous coronary intervention (PCI). There have been no studies that compared the outcomes of orbital atherectomy (OA) and rotational atherectomy (RA) in obese patients. METHODS: A total of 35,590 patients from five tertiary-care hospitals who underwent PCI between January 2011 to April 2016 were identified. All adult patients with body mass index ≥30 kg/ m2 who had OA or RA prior to PCI were included in this analysis. A total of 91 patients were included in the OA arm and 131 patients in the RA arm prior to the matching. To remove potential selection bias, a propensity-score matched analysis was performed, and 69 patients were included in each group. RESULTS: The primary endpoint, composite of safety outcomes, did not occur in any patient of either group. The secondary endpoints - death on discharge (0.0% vs 1.5%; P=.48) and myocardial infarction (2.9% vs 6.4%; P=.42) - were similar between groups, as were individual outcomes including cardiogenic shock, bleeding complications, and congestive heart failure. Stroke, vascular complications, and the requirement for dialysis initiation did not occur in any of the patients. CONCLUSION: In this study assessing atherectomy in obese patients, OA and RA demonstrated comparable outcomes with complication rates within an acceptable range. It demonstrates that OA and RA can be safely performed in this high-risk patient subset with CAC.

Comparison of Outcomes and Cost of Endovascular Management Versus Surgical Bypass for the Management of Lower Extremities Peripheral Arterial Disease.

The management of lower extremities peripheral arterial disease (LE-PAD) has always been debatable. We sought to explore in-hospital outcomes in hospitalizations that underwent endovascular or bypass surgery for LE-PAD from nation's largest, publicly available database. The National Inpatient Sample from 2012 to 2014 was queried to identify adult hospitalizations underwent endovascular management and bypass surgery for LE-PAD. Appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes were utilized to identify hospitalizations. A total of 89,256 hospitalizations were identified having endovascular management or bypass surgery for LE-PAD. More hospitalizations underwent endovascular intervention as compared with bypass surgery. Overall, hospitalizations for endovascular management had higher baseline co-morbidities and older age. A propensity score matched analysis was performed to compare in-hospital outcomes. After matching, 28,791 hospitalizations were included in each group. In-hospital mortality was significantly lower with endovascular intervention procedure as compared with surgical bypass group (1.5% vs 2.5%, p ≤0.001). All other secondary outcomes were noted lower with endovascular management except stroke and postprocedural infection. Taken together, these may account for higher discharges to home, lower length of stay, and less cost of hospitalizations associated with endovascular management. In conclusion, endovascular management is associated with lower in-hospital morbidity, mortality, length of stay, and cost when compared with bypass surgery in this study.