Increasing endovascular treatment for CLI linked with lower mortality

CHICAGO — Between 2003 and 2011, patients with critical limb ischemia were increasingly treated with endovascular revascularization instead of surgery, and mortality rates dropped.

Using data from the Nationwide Inpatient Sample, the researchers characterized trends in hospitalization of 642,433 U.S. patients who were admitted with CLI from 2003 to 2011.

The primary outcomes were in-hospital mortality and amputation. Secondary outcomes included length of stay and hospitalization costs.

Mehdi H. Shishehbor, DO, MPH, PhD, and colleagues reported that the annual rate of CLI admissions was consistent from 2003 to 2011, with a rate of approximately 150 per 100,000 patients each year.

Mehdi H. Shishehbor

Surgical revascularization rates dropped from 13.9% in 2003 to 8.8% in 2011 (P for trend < .001).

Conversely, rates of endovascular revascularization increased from 5.1% in 2003 to 11% in 2011 (P for trend < .001).

During the study period, in-hospital mortality rates declined from 5.4% in 2003 to 3.4% in 2011 (P for trend < .001), and major amputation rates declined from 16.7% in 2003 to 10.8% in 2011 (P for trend < .001), according to the researchers.

Length of stay decreased from 10 days in 2003 to 8.4 days in 2011 (P for trend < .001). The cost of hospitalization did not change over time (P for trend = .1).

Shishehbor and colleagues determined that endovascular revascularization was associated with lower in-hospital mortality (2.34% vs. 2.73%; P < .001), mean length of stay (8.7 days vs. 10.7 days, P < .001) and mean hospitalization cost ($31,679 vs. 32,485; P < .001) compared with surgery. There was no difference between the therapies in rate of major amputation (endovascular, 6.5%; surgery, 5.7%; P = .75).

Compared with men, women had higher rates of in-hospital mortality but lower rates of amputation, according to the data.

“Although the results are encouraging, there remain significant disparities and gaps in the care of CLI patients that must be addressed,” Shishehbor, from the department of cardiovascular medicine at the Cleveland Clinic Heart and Vascular Institute and Cardiology Today’s Intervention Editorial Board member, and colleagues wrote in the Journal of the American College of Cardiology. – by Erik Swain

Reference s :

Agarwal S, et al. Abstract 1289M-01. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Agarwal S, et al. J Am Coll Cardiol. 2016;doi:10.1016/j.jacc.02.040.

Disclosure: The researchers report no relevant financial disclosures.