Doshi Rajkumar, Shlofmitz Evan, Meraj Perwaiz
Department of Cardiology, 24945 North Shore University Hospital , Manhasset, NY, USA.
Vascular. 2018 Oct;26(5):464-471. doi: 10.1177/1708538118760135. Epub 2018 Feb 21.
Objective Percutaneous revascularization for patients with peripheral arterial disease has become a treatment of choice for many symptomatic patients. The presence of severe arterial calcification presents many challenges for successful revascularization. Atherectomy is an adjunctive treatment option for patients with severe calcification undergoing percutaneous intervention. We sought to analyze the impact of atherectomy on in-hospital outcomes, length of stay, and cost in the percutaneous treatment of peripheral arterial disease. Methods Patients with lower extremity peripheral arterial disease undergoing percutaneous revascularization were assessed, utilizing the National Inpatient Sample (2012-2014) and appropriate International Classification of Diseases, 9th Revision, Clinical Modification diagnostic and procedural codes. Patients who were not treated with atherectomy ( n = 51,037) were compared to those treated with atherectomy ( n = 11,408). Propensity score-matched analysis was performed to address baseline differences. Results After performing propensity score-matched analysis, 11,037 patients were included in each group. Utilization of atherectomy was associated with lower in-hospital mortality (2% vs. 1.4% p = 0.0006). All secondary outcomes were lower when using atherectomy except acute renal failure. Length of stay was slightly lower when using atherectomy (7.2 vs. 7.0 days, p = 0.0494). However, median cost was higher in patients treated with atherectomy ($21,589 vs. $24,060, p = <0.0001). Conclusion The use of atherectomy was associated with significantly decreased in-hospital mortality, adverse events, and length of stay. Though, cost associated with atherectomy use is increased, this is offset by decreased in-hospital adverse outcomes. Appropriate use of atherectomy devices is an important tool in revascularization of peripheral arterial disease in select patients.
目的 对于外周动脉疾病患者，经皮血管重建术已成为许多有症状患者的首选治疗方法。严重动脉钙化的存在给成功的血管重建带来了诸多挑战。旋切术是接受经皮介入治疗的严重钙化患者的一种辅助治疗选择。我们试图分析旋切术对外周动脉疾病经皮治疗的住院结局、住院时间和费用的影响。方法 利用国家住院患者样本（2012 - 2014年）以及适当的国际疾病分类第九版临床修订本诊断和程序编码，对接受经皮血管重建术的下肢外周动脉疾病患者进行评估。将未接受旋切术治疗的患者（n = 51,037）与接受旋切术治疗的患者（n = 11,408）进行比较。进行倾向评分匹配分析以解决基线差异。结果 进行倾向评分匹配分析后，每组纳入11,037例患者。旋切术的使用与较低的住院死亡率相关（2% 对1.4%，p = 0.0006）。使用旋切术时，除急性肾衰竭外，所有次要结局均较低。使用旋切术时住院时间略短（7.2天对7.0天，p = 0.0494）。然而，接受旋切术治疗的患者中位费用更高（21,589美元对24,060美元，p = <0.0001）。结论 旋切术的使用与显著降低的住院死亡率、不良事件和住院时间相关。虽然，旋切术使用相关的费用增加，但这被住院不良结局的减少所抵消。在特定患者中适当使用旋切术装置是外周动脉疾病血管重建的重要工具。
