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Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography
Journal article   Peer reviewed

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

Vikas Singh, Apurva O Badheka, Shilpkumar Arora, Sidakpal S Panaich, Nileshkumar J Patel, Nilay Patel, Sadip Pant, Badal Thakkar, Ankit Chothani, Abhishek Deshmukh, …
The American journal of cardiology, Vol.115(10), pp.1357-1366
05/15/2015
DOI: 10.1016/j.amjcard.2015.02.037
PMID: 25824542

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Abstract

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.
 Coronary Vessels - diagnostic imaging Postoperative Complications - economics Ultrasonography, Interventional - methods United States - epidemiology Coronary Artery Disease - surgery Postoperative Complications - etiology Follow-Up Studies Percutaneous Coronary Intervention - mortality Humans Middle Aged Male Hospital Mortality - trends Young Adult Coronary Angiography - methods Aged, 80 and over Adult Female Retrospective Studies Costs and Cost Analysis Surgery, Computer-Assisted - methods Postoperative Complications - epidemiology Coronary Artery Disease - mortality Coronary Artery Disease - diagnosis Health Care Costs - statistics & numerical data Adolescent Length of Stay - trends Coronary Vessels - surgery Aged Percutaneous Coronary Intervention - economics Percutaneous Coronary Intervention - adverse effects

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