title: Coronary Atherectomy in the United States (from a Nationwide Inpatient Sample).
abstract: Contemporary real-world data on clinical outcomes after utilization of coronary atherectomy are sparse. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from year 2012. Percutaneous coronary interventions including atherectomy were identified using appropriate International Classification of Diseases, 9th Revision diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The primary outcome was a composite of in-hospital mortality and periprocedural complications; the secondary outcome was in-hospital mortality. Hospitalization costs were also assessed. A total of 107,131 procedures were identified in 2012. Multivariate analysis revealed that atherectomy utilization was independently predictive of greater primary composite outcome of in-hospital mortality and complications (odds ratio 1.34, 95% confidence interval 1.22 to 1.47, p <0.001) but was not associated with any significant difference in terms of in-hospital mortality alone (odds ratio 1.22, 95% confidence interval 0.99 to 1.52, p 0.063). In the propensity-matched cohort, atherectomy utilization was again associated with a higher rate of complications (12.88% vs 10.99%, p = 0.001), in-hospital mortality +a ny complication (13.69% vs 11.91%, p = 0.003) with a nonsignificant difference in terms of in-hospital mortality alone (3.45% vs 2.88%, p = 0.063) and higher hospitalization costs ($25,341 ± 353 vs $21,984 ± 87, p <0.001). Atherectomy utilization during percutaneous coronary intervention is associated with a higher rate of postprocedural complications without any significant impact on in-hospital mortality.
authors.affiliation: Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cardiology Department, Borges Medical Center, Kalamazoo, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Epidemiology Department, New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Epidemiology Department, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: Public Health Department, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sonani
authors.affiliation: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Internal Medicine Department, Jersey City Medical Center, Jersey City, New Jersey.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Public Health Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Epidemiology Department, Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Internal Medicine Department, St. Anthony's Hospital, Oklahoma City, Oklahoma.
authors.forename: Harshil
authors.initials: H
authors.lastname: Shah
authors.affiliation: John H Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Radhika
authors.initials: R
authors.lastname: Jaiswal
authors.affiliation: Cardiology Department, Borges Medical Center, Kalamazoo, Michigan.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Interventional Cardiology Division, Cardiology Department, The Everett Clinic, Everett, Washington. Electronic address: abadheka@everettclinic.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Cardiology Department, 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; D017225:Atherectomy, Coronary / Q000191:economics / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult