Drug-eluting versus nondrug peripheral vascular interventions.

Tariq Enezate, Anandbir Singh Bath, Viswanatha Chinta, Jad Omran
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Abstract

Introduction: Drug-eluting (DRUG) peripheral vascular interventions (PVIs) are associated with higher patency rates than nondrug (NONDRUG) PVIs. Recent data raised safety concerns with using DRUG devices in PVIs.

Material and methods: The study population was extracted from the 2016 Nationwide Readmissions Database using the International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for PVI, DRUG and NONDRUG devices, and in-hospital procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospitalization, acute kidney injury (AKI), amputation, compartment syndrome, vascular complications, bleeding, and blood transfusion. Propensity matching was used to adjust for baseline characteristics.

Results: 49,883 discharged patients who underwent lower extremity arterial PVI were identified, 25.3% DRUG and 74.7% NONDRUG PVI. Mean age was 68.3 years and 40.6% were female. Critical limb ischemia was reported in 33.2%, claudication in 7.6%, and acute limb ischemia in 0.1%. In comparison to the NONDRUG group, the DRUG group was associated with lower in-hospital all-cause mortality (2.2 vs. 2.9%, p < 0.001), shorter length of index hospitalization (8.3 vs. 8.6 days, p = 0.001), bleeding (12.0% vs. 13.5%, p < 0.001), and need for blood transfusion (10.1% vs. 11.0%, p = 0.004). There was no significant difference in terms of AKI (17.3% vs. 18.0%, p = 0.10), amputation (15.3% vs. 15.4%, p = 0.63), compartment syndrome (0.5% vs. 0.6%, p = 0.07), or vascular complications (0.8% vs. 0.8%, p = 0.50). After propensity matching, the mortality benefit was no longer present.

Conclusions: DRUG PVI was associated with lower in-hospital all-cause mortality, bleeding events and shorter length of index hospitalization and comparable vascular-related complications. However, this mortality benefit was no longer present after propensity matching.

药物洗脱与非药物外周血管干预。
药物洗脱(DRUG)外周血管干预(PVIs)与非药物(nondrug) PVIs相比具有更高的通畅率。最近的数据提高了在PVIs中使用药物器械的安全性。材料和方法:研究人群从2016年全国再入院数据库中提取,使用国际疾病分类第十版,PVI的临床修改/程序编码系统代码,药物和非药物器械,以及院内程序并发症。研究终点包括院内全因死亡率、指数住院时间、急性肾损伤(AKI)、截肢、筋膜室综合征、血管并发症、出血和输血。倾向匹配用于调整基线特征。结果:49,883例下肢动脉性PVI出院患者中,药物性PVI占25.3%,非药物性PVI占74.7%。平均年龄68.3岁,女性40.6%。重度肢体缺血占33.2%,跛行占7.6%,急性肢体缺血占0.1%。与non - DRUG组相比,DRUG组的住院全因死亡率较低(2.2 vs. 2.9%, p < 0.001)、指标住院时间较短(8.3 vs. 8.6天,p = 0.001)、出血(12.0% vs. 13.5%, p < 0.001)和输血需求(10.1% vs. 11.0%, p = 0.004)。在AKI (17.3% vs. 18.0%, p = 0.10)、截肢(15.3% vs. 15.4%, p = 0.63)、筋膜室综合征(0.5% vs. 0.6%, p = 0.07)或血管并发症(0.8% vs. 0.8%, p = 0.50)方面,两组无显著差异。倾向匹配后,死亡率收益不再存在。结论:药物PVI与较低的院内全因死亡率、出血事件、较短的指数住院时间和类似的血管相关并发症相关。然而,这种死亡率优势在倾向匹配后不再存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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