Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia, USA.
Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA.
J Ultrasound Med. 2019 Sep;38(9):2295-2304. doi: 10.1002/jum.14922. Epub 2019 Jan 4.
Intravascular ultrasonography (IVUS) and coronary atherectomy (CA) are useful modalities in managing calcified coronary lesions. Considering an inadequacy of data, we aimed to compare the outcomes with versus without IVUS assistance in percutaneous coronary interventions (PCIs) with CA.
From the National (Nationwide) Inpatient Sample data set for the years 2012 to 2014, we identified adult patients undergoing PCI and CA with or without IVUS assistance using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We assessed the impact of IVUS on procedural outcomes, length of stay, total hospital charges, and predictors of IVUS utilization by multivariable analyses. Discharge weights were used to calculate national estimates.
A total of 46,095 PCIs with CA procedures were performed from 2012 to 2014, of these, 4800 (10.4%) procedures were IVUS-assisted. IVUS-assisted procedures showed lower odds of in-hospital mortality (odds ratio, 0.57; P = .024) but higher odds of any cardiac complication (odds ratio, 1.25; P = .025). Total hospital charges were higher in IVUS-assisted procedures without any substantial difference in the length of stay between the groups. Cardiac complication rates declined (from 16.2% to 14.8%) from 2012 to 2014, whereas inpatient mortality increased (1.1%-4.4%) in IVUS-assisted procedures during the same period. The odds of IVUS utilization were higher in Asian/Pacific Islander and urban teaching and western region hospitals. Comorbidities, including hypertension, obesity, and chronic pulmonary disease, raised odds of IVUS utilization.
IVUS-assisted procedures showed lower in-hospital mortality and higher iatrogenic and overall cardiac complications. The mortality rate in patients undergoing IVUS-assisted PCI with CA was on the rise, with declining cardiac complication rates from 2012 to 2014.
血管内超声（IVUS）和冠状动脉旋磨术（CA）在处理钙化性冠状动脉病变方面是有用的手段。考虑到数据不足，我们旨在比较在接受 CA 的经皮冠状动脉介入治疗（PCI）中有无 IVUS 辅助的治疗结果。
我们从 2012 年至 2014 年的国家（全国）住院患者样本数据库中，使用国际疾病分类，第九修订版，临床修正代码，确定了接受 PCI 和 CA 治疗的成年患者，无论是否使用 IVUS 辅助。我们通过多变量分析评估了 IVUS 对程序结果、住院时间、总住院费用的影响，以及 IVUS 使用的预测因素。使用出院权重计算全国估计数。
在 2012 年至 2014 年期间，共进行了 46095 例接受 CA 治疗的 PCI 手术，其中 4800 例（10.4%）手术为 IVUS 辅助手术。IVUS 辅助手术的院内死亡率较低（优势比，0.57；P = .024），但任何心脏并发症的发生率较高（优势比，1.25；P = .025）。IVUS 辅助手术的总住院费用较高，但两组之间的住院时间没有明显差异。从 2012 年到 2014 年，心脏并发症的发生率从 16.2%下降到 14.8%，而同期 IVUS 辅助手术的住院死亡率从 1.1%上升到 4.4%。在亚洲/太平洋岛民和城市教学医院和西部地区医院中，IVUS 使用率较高。包括高血压、肥胖和慢性肺部疾病在内的合并症增加了 IVUS 的使用几率。
IVUS 辅助手术显示出较低的院内死亡率和较高的医源性和总体心脏并发症。接受 IVUS 辅助 PCI 联合 CA 治疗的患者死亡率呈上升趋势，2012 年至 2014 年心脏并发症发生率下降。
