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Concomitant percutaneous aortic balloon balvotomy plus PCI did not improve outcomes, increased costs
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Compared with percutaneous aortic balloon balvotomy alone, PCI plus percutaneous aortic balloon balvotomy performed during the same hospitalization was associated with similar in-hospital mortality and complication rates, but increased hospitalization costs among patients aged older than 60 years with aortic stenosis.
The development of less-invasive endovascular therapies has yielded a resurgence in the utilization of percutaneous aortic balloon balvotomy (PABV) for high-risk patients as a bridge to transcatheter aortic valve replacement. Using the National Inpatient Sample database (1998-2010), researchers compared outcomes of PABV alone (n = 1,880) with concomitant PCI plus PAVB (n = 247) in a total of 2,127 procedures.
The use of PCI plus PABV during the same hospitalization increased 225%, from 5.1% of PABVs in 1998 to 1999 to 16.6% of PABVs in 2009 to 2010 (P < .001).
The in-hospital mortality rate was 10.3% in the PCI plus PABV group vs. 10.5% in the PABV alone group. The researchers found that increasing comorbidities (OR = 1.17; 95% CI, 1.01-1.35), unstable patient condition (OR = 6.19; 95% CI, 3.45-11.09), complications (OR = 2.81; 95% CI, 1.85-4.28) and weekend admission (OR = 2.12; 95% CI, 1.23-3.67) were significant predictors of in-hospital mortality after concomitant PCI plus PABV.
The rate of in-hospital complications was also similar: 23.4% in the PCI plus PABV group vs. 24.7% in the PABV alone group. The most common complications were postprocedure respiratory failure (8.3%), vascular (7.5%) and cardiac (6.7%). Unstable patient condition was a significant predictor of increased complications (OR = 5.09; 95% CI, 2.97-8.7).
While both groups had a similar length of stay, patients who underwent PCI plus PABV had higher costs of hospitalization ($30,089 vs. $18,421; P < .001).
Unstable condition, complications and weekend admission were significant predictors of longer length of hospital stay and higher costs of admission. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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