In-Hospital Outcomes of Atherectomy during Endovascular Lower Extremity Revascularization

Sidakpal S. Panaich, Shilpkumar Arora, Nilay Patel, Nileshkumar J. Patel, Samir V. Patel, Chirag Savani, Vikas Singh, Sunny Jhamnani, Rajesh Sonani, Sopan Lahewala, Badal Thakkar, Achint Patel, Abhishek Dave, Harshil Shah, Parth Bhatt, Radhika Jaiswal, Abhijit Ghatak, Vishal Gupta, Abhishek Deshmukh, Ashok KondurTheodore Schreiber, Cindy Grines, Apurva O. Badheka

Research output: Contribution to journalArticlepeer-review

Abstract

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications.

Original languageEnglish (US)
Pages (from-to)676-684
Number of pages9
JournalAmerican Journal of Cardiology
Volume117
Issue number4
DOIs
StatePublished - Feb 15 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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