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Atherectomy confers lower in-hospital mortality rate in PAD
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In an analysis of propensity-score matched patients with peripheral artery disease, those who underwent atherectomy had a lower mortality rate than those who did not, researchers reported.
Atherectomy was associated with higher median costs, but this was offset by lower in-hospital adverse outcomes, Rajkumar Doshi, MD, from the department of cardiology at North Shore University Hospital, and colleagues wrote.
Doshi and colleagues retrospectively analyzed patients with lower-extremity PAD who underwent percutaneous revascularization from 2012 to 2014 and were included in the National Inpatient Sample. After propensity matching was performed to adjust for baseline differences, the analysis included 11,037 patients who had atherectomy (mean age, 70 years; 57% men) and 11,037 who did not (mean age, 70 years; 56% men).
The primary outcome was all-cause in-hospital mortality. Secondary outcomes included acute renal failure, in-hospital stroke, transfusion, length of stay and median cost of hospitalization.
In-hospital mortality was lower in the atherectomy group (1.4% vs. 2%; OR = 1.44; 95% CI, 1.17-1.77), according to the researchers.
The atherectomy group also had lower rates of stroke (0.7% vs. 1%; OR = 1.4; 95% CI. 1.04-1.88), blood loss requiring transfusion (10.9% vs. 12.5%; OR = 1.17; 95% CI, 1.08-1.27) and death or stroke (2% vs. 2.8%; OR = 1.44; 95% CI, 1.21-1.71), they wrote. Acute renal failure did not differ between the groups (atherectomy, 13.7%; no atherectomy, 12.8%; OR = 0.93; 95% CI, 0.86-1.01).
Length of stay was shorter in the atherectomy group (7 days vs. 7.2 days; P = .0494), but the median cost of hospitalization was higher ($24,060 vs. $21,589; P < .0001), Doshi and colleagues found.
“Possible reasons [for the in-hospital mortality difference] could include improved procedural success translating to a reduction in periprocedural complications; however, any causation is unproven,” Doshi and colleagues wrote. “Treatment with atherectomy devices may aid complete revascularization and complete revascularization has been associated with reduced in-hospital mortality in percutaneous coronary intervention. Additionally, in-hospital adverse events including stroke and blood loss requiring transfusion occurred less often in patients treated with atherectomy. Though we cannot derive a causal relationship from these data, the use of atherectomy in this high-risk patient population can facilitate revascularization, notably with no increased association of adverse events.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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