title: Comparison of outcomes of balloon aortic valvuloplasty plus percutaneous coronary intervention versus percutaneous aortic balloon valvuloplasty alone during the same hospitalization in the United States.
abstract: The use of percutaneous aortic balloon balvotomy (PABV) in high surgical risk patients has resurged because of development of less invasive endovascular therapies. We compared outcomes of concomitant PABV and percutaneous coronary intervention (PCI) with PABV alone during same hospitalization using nation's largest hospitalization database. We identified patients and determined time trends using the International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code for valvulotomy from Nationwide Inpatient Sample database 1998 to 2010. Only patients >60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications, length of stay (LOS), and cost of hospitalization. Total 2,127 PABV procedures were identified, with 247 in PABV + PCI group and 1,880 in the PABV group. Utilization rate of concomitant PABV + PCI during same hospitalization increased by 225% from 5.1% in 1998 to 1999 to 16.6% in 2009 to 2010 (p <0.001). Overall in-hospital mortality rate and complication rates in PABV + PCI group were similar to that of PABV group (10.3% vs 10.5% and 23.4% vs 24.7%, respectively). PABV + PCI group had similar LOS but higher hospitalization cost (median [interquartile range] $30,089 [$21,925 to $48,267] versus $18,421 [$11,482 to $32,215], p <0.001) in comparison with the PABV group. Unstable condition, occurrence of any complication, and weekend admission were the main predictors of increased LOS and cost of hospital admission. Concomitant PCI and PABV during the same hospitalization are not associated with change in in-hospital mortality, complications rate, or LOS compared with PABV alone; however, it increases the cost of hospitalization.
authors.affiliation: Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Cardiovascular division, Staten Island University Hospital, Staten Island, New York.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Cardiovascular division, Yale School of Medicine, New Haven, Connecticut. Electronic address: apurva.badheka@yale.edu.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Cardiovascular division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiovascular division, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Conrad
authors.initials: C
authors.lastname: Macon
authors.affiliation: Cardiovascular division, Prince George's Hospital Center, Cheverly, Maryland.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Cardiovascular division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.affiliation: Cardiovascular division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cardiovascular division, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Cardiovascular division, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Vinaykumar
authors.initials: V
authors.lastname: Panchal
authors.affiliation: Cardiovascular division, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Shantanu
authors.initials: S
authors.lastname: Solanki
authors.affiliation: Cardiovascular division, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Cardiovascular division, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Cardiovascular division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Cardiovascular division, University of Arizona, Tucson, Arizona.
authors.forename: Vinny
authors.initials: V
authors.lastname: Ram
authors.affiliation: Cardiovascular division, Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Kliger
authors.affiliation: Cardiovascular division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Cardiovascular division, Henry Ford Hospital, Detroit, Michigan.
authors.forename: William
authors.initials: W
authors.lastname: O' Neill
authors.affiliation: Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Cardiovascular division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Cardiovascular division, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Abeel
authors.initials: A
authors.lastname: Mangi
authors.affiliation: Cardiovascular division, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Steven
authors.initials: S
authors.lastname: Pfau
authors.affiliation: Cardiovascular division, Yale School of Medicine, New Haven, Connecticut.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: Cardiovascular division, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Cardiovascular division, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D063126:Balloon Valvuloplasty; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology