title: Impact on in-hospital outcomes with drug-eluting stents versus bare-metal stents (from 665,804 procedures).
abstract: Contemporary large-scale data, regarding in-hospital outcomes depending on the types of stent used for percutaneous coronary intervention (PCI) is lacking. We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2006 to 2011 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 36.06 (bare-metal coronary artery stent, BMS) or 36.07 (drug-eluting coronary artery stent, DES) for PCI. All analyses were performed using the designated weighting specified to the Nationwide Inpatient Sample database to minimize bias. Primary outcome was in-hospital mortality. Wald's chi-square test was used for categorical variables. We built a hierarchical 2 level model adjusted for multiple confounding factors, with hospital identification incorporated as random effects in the model and propensity match analyses were used to adjust confounding variables. A total of 665,804 procedures were analyzed, which were representative of 3,277,884 procedures in the United States. Use of bare-metal stents (BMS) was associated with greater occurrence of in-hospital mortality compared with that of drug-eluting stents (DES; 1.4% vs 0.5%, p <0.001). The association stayed significant after adjustment of various possible confounding factors (odds ratio for DES versus BMS 0.59 [0.54 to 0.64, p <0.001]) and also in propensity matched cohorts (1.2% vs 0.7%, p <0.001). The results continued to be similar in the following high-risk subgroups: diabetes (0.57 [0.50 to 0.64, <0.001]), acute myocardial infarction and/or shock (0.53 [0.49 to 0.57, <0.001]), age >80 (0.66 [0.58 to 0.74, <0.001]), and multivessel PCI (0.55 [0.46 to 0.66, <0.001]). In conclusion, DES use was associated with lesser in-hospital mortality compared with BMS. This outcome benefit was seen across subgroups in various subgroups including elderly, diabetics, and acute myocardial infarction as well as multivessel interventions.
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan. Electronic address: apurva_badheka@yahoo.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Department of Cardiology, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Department of Cardiology, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania.
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.affiliation: Department of Cardiology, University of Arkansas, Little Rock, Arkansas.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Kanishk
authors.initials: K
authors.lastname: Agnihotri
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Peeyush
authors.initials: P
authors.lastname: Grover
authors.affiliation: Department of Cardiology, Mount Sinai Hospital, New York, New York.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Department of Cardiology, Mount Sinai Hospital, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bambhroliya
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Mahir
authors.initials: M
authors.lastname: Elder
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Amir
authors.initials: A
authors.lastname: Kaki
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohammad
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Department of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome