Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography.

Autor: Singh V; Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida., Badheka AO; Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut. Electronic address: apurva.badheka@yale.edu., Arora S; Cardiovascular Division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York., Panaich SS; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Patel NJ; Cardiovascular Division, Staten Island University Hospital, Staten Island, New York., Patel N; Cardiovascular Division, Saint Peter's University Hospital, New Brunswick, New Jersey., Pant S; Cardiovascular Division, University of Louisville, Louisville, Kentucky., Thakkar B; Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana., Chothani A; Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia., Deshmukh A; Cardiovascular Division, Mayo Clinic, Rochester, Minnesota., Manvar S; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Lahewala S; Cardiovascular Division, Icahn School of Medicine at Mount Sinai, New York, New York., Patel J; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Patel S; Cardiovascular Division, Western Reserve Health System, Youngstown, Ohio., Jhamnani S; Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut., Bhinder J; Cardiovascular Division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York., Patel P; Cardiovascular Division, Drexel School of Public Health, Philadelphia, Pennsylvania., Savani GT; Cardiovascular Division, Prince George's Hospital Center, Cheverly, Maryland., Patel A; Cardiovascular Division, Icahn School of Medicine at Mount Sinai, New York, New York., Mohamad T; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Gidwani UK; Cardiovascular Division, Icahn School of Medicine at Mount Sinai, New York, New York., Brown M; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Forrest JK; Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut., Cleman M; Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut., Schreiber T; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan., Grines C; Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2015 May 15; Vol. 115 (10), pp. 1357-66. Date of Electronic Publication: 2015 Feb 18.
DOI: 10.1016/j.amjcard.2015.02.037
Abstrakt: Despite the valuable role of intravascular ultrasound (IVUS) guidance in percutaneous coronary interventions (PCIs), its impact on clinical outcomes remains debatable. The aim of the present study was to compare the outcomes of PCIs guided by IVUS versus angiography in the contemporary era on inhospital outcomes in an unrestricted large, nationwide patient population. Data were obtained from the Nationwide Inpatient Sample from 2008 to 2011. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables like inhospital mortality, and hierarchical mixed-effects linear regression models were used for continuous dependent variables like length of hospital stay and cost of hospitalization. A total of 401,571 PCIs were identified, of which 377,096 were angiography guided and 24,475 (weighted n = 119,102) used IVUS. In a multivariate model, significant predictors of higher mortality were increasing age, female gender, higher baseline co-morbidity burden, presence of acute myocardial infarction, shock, weekend and emergent admission, or occurrence of any complication during hospitalization. Significant predictors of reduced mortality were the use of IVUS guidance (odds ratio 0.65, 95% confidence interval 0.52 to 0.83; p <0.001) for PCI and higher hospital volumes (third and fourth quartiles). The use of IVUS was also associated with reduced inhospital mortality in subgroup of patients with acute myocardial infarction and/or shock and those with a higher co-morbidity burden (Charlson's co-morbidity index ≥2). In one of the largest studies on IVUS-guided PCIs in the drug-eluting stent era, we demonstrate that IVUS guidance is associated with reduced inhospital mortality, similar length of hospital stay, and increased cost of care and vascular complications compared with conventional angiography-guided PCIs.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: