title: Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography.
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.
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, 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, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
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, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, University of Louisville, Louisville, Kentucky.
authors.forename: Sadip
authors.initials: S
authors.lastname: Pant
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, MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Cardiovascular Division, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Sohilkumar
authors.initials: S
authors.lastname: Manvar
authors.affiliation: Cardiovascular Division, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: Cardiovascular Division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York.
authors.forename: Jasjit
authors.initials: J
authors.lastname: Bhinder
authors.affiliation: Cardiovascular Division, Drexel School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Parshva
authors.initials: P
authors.lastname: Patel
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, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Cardiovascular Division, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Umesh K
authors.initials: UK
authors.lastname: Gidwani
authors.affiliation: Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
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, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Cardiovascular Division, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult