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紫杉醇器械治疗外周动脉疾病的真实世界安全性分析。

Real-World Safety Analysis of Paclitaxel Devices Used for the Treatment of Peripheral Artery Disease.

机构信息

Division of Cardiovascular Medicine, Comparative Effective Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts.

Division of Cardiovascular Medicine, Comparative Effective Research Institute, Lahey Hospital and Medical Center, Burlington, Massachusetts.

出版信息

J Vasc Interv Radiol. 2023 Jul;34(7):1157-1165.e8. doi: 10.1016/j.jvir.2023.03.014. Epub 2023 Mar 25.

Abstract

PURPOSE

To investigate the real-world safety of paclitaxel (PTX)-coated devices for treating lower extremity peripheral artery disease using a commercial claims database.

MATERIALS AND METHODS

Data from FAIR Health, the largest commercial claims data warehouse in the United States, were used for this study. The study consisted of patients who underwent femoropopliteal revascularization procedures between January 1, 2015, and December 31, 2019, with PTX and non-PTX devices. The primary outcome was 4-year survival following treatment. The secondary outcomes included 2-year survival, 2- and 4-year freedom from amputation, and repeat revascularization. Propensity score matching was used to minimize confounding, and the Kaplan-Meier methods were used to estimate survival.

RESULTS

A total of 10,832 procedures were included in the analysis, including 4,962 involving PTX devices and 5,870 involving non-PTX devices. PTX devices were associated with a reduced hazard of death following treatment at 2 and 4 years (hazard ratio [HR], 0.74 [95% confidence interval {CI}, 0.69-0.79]; P <.05, and HR, 0.89 [95% CI, 0.77-1.02]; log-rank P =.018, respectively). The risk of amputation was also lower following treatment with PTX devices than with non-PTX devices at 2 and 4 years (HR, 0.82 [95% CI, 0.76-0.87]; P =.02, and HR, 0.77 [95% CI, 0.67-0.89]; log-rank P =.01, respectively). In addition, the odds of repeat revascularization were similar with PTX and non-PTX devices at 2 and 4 years.

CONCLUSIONS

In the real-world commercial claims database, no short- or long-term signal for increased mortality or amputations was observed following treatment with PTX devices.

摘要

目的

利用商业索赔数据库,调查紫杉醇(PTX)涂层器械治疗下肢外周动脉疾病的真实世界安全性。

材料和方法

本研究使用了美国最大的商业索赔数据仓库 FAIR Health 的数据。研究包括 2015 年 1 月 1 日至 2019 年 12 月 31 日期间接受股腘动脉血运重建术的患者,他们使用了 PTX 和非 PTX 器械。主要结局是治疗后的 4 年生存率。次要结局包括 2 年生存率、2 年和 4 年免于截肢率和再次血运重建率。采用倾向评分匹配法最小化混杂因素,并采用 Kaplan-Meier 方法估计生存率。

结果

共有 10832 例手术纳入分析,其中 4962 例涉及 PTX 器械,5870 例涉及非 PTX 器械。与非 PTX 器械相比,PTX 器械在治疗后 2 年和 4 年的死亡风险降低(风险比 [HR],0.74 [95%置信区间 {CI},0.69-0.79];P <.05,和 HR,0.89 [95% CI,0.77-1.02];对数秩 P =.018,分别)。在 2 年和 4 年时,与非 PTX 器械相比,PTX 器械治疗后截肢的风险也较低(HR,0.82 [95% CI,0.76-0.87];P =.02,和 HR,0.77 [95% CI,0.67-0.89];对数秩 P =.01,分别)。此外,在 2 年和 4 年时,PTX 和非 PTX 器械再次血运重建的几率相似。

结论

在真实世界的商业索赔数据库中,PTX 器械治疗后没有观察到死亡率或截肢率增加的短期或长期信号。

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