title: Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006-2011).
abstract: OBJECTIVE
  The aim of our study was to study the impact of glycoprotein IIb/IIIa inhibitors (GPI) on in-hospital outcomes.
  
  
  BACKGROUND
  There is paucity of data regarding the impact of GPI on the outcomes following peripheral endovascular interventions.
  
  
  METHODS
  The study cohort was derived from Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between the years 2006 and 2011. Peripheral endovascular interventions and GPI utilization were identified using appropriate ICD-9 Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The study outcomes were: primary (in-hospital mortality and amputation studied separately) and secondary (composite of in-hospital mortality and postprocedural complications). Hospitalization costs were also assessed.
  
  
  RESULTS
  GPI utilization (OR, 95% CI, P-value) was independently predictive of lower amputation rates (0.36, 0.27-0.49, <0.001). There was no significant difference in terms of in-hospital mortality (0.59, 0.31-1.14, P 0.117), although GPI use predicted worse secondary outcomes (1.23, 1.03-1.47, 0.023). Following propensity matching, the amputation rate was lower (3.2% vs. 8%, P < 0.001), while hospitalization costs were higher in the cohort that received GPI ($21,091 ± 404 vs. 19,407 ± 133, P < 0.001).
  
  
  CONCLUSIONS
  Multivariate analysis revealed GPI use in peripheral endovascular interventions to be suggestive of an increase in composite end-point of in-hospital mortality and postprocedural complications, no impact on in-hospital mortality alone, significantly lower rate of amputation, and increase in hospitalization costs. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Mount Sinai St. Luke's Roosevelt Hospital, New York.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Borgess Medical Center, Kalamazoo, Michigan.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Saint Peter's University Hospital, New Brunswick, New Jersey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Jersey City Medical Center, Jersey City, New Jersey.
authors.forename: Sopan
authors.initials: S
authors.lastname: Lahewala
authors.affiliation: Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Badal
authors.initials: B
authors.lastname: Thakkar
authors.affiliation: New York Medical College, Valhalla, New York.
authors.forename: Chirag
authors.initials: C
authors.lastname: Savani
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Sunny
authors.initials: S
authors.lastname: Jhamnani
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.affiliation: Western Reserve Health System, Youngstown, Ohio.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Public Health Department, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sonani
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Mount Sinai St. Luke's Roosevelt Hospital, New York.
authors.forename: Byomesh
authors.initials: B
authors.lastname: Tripathi
authors.affiliation: Mayo Clinic, Rochester, Minnesota.|MedStar Washington Hospital Center, Washington, DC.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Mount Sinai St. Luke's Roosevelt Hospital, New York.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.affiliation: Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana.
authors.forename: Parth
authors.initials: P
authors.lastname: Bhatt
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Remetz
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Ramak R
authors.initials: RR
authors.lastname: Attaran
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Carlos I
authors.initials: CI
authors.lastname: Mena
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: Michael
authors.initials: M
authors.lastname: Cleman
authors.affiliation: Yale School of Medicine, New Haven, Connecticut.
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: The Everett Clinic, Everett, Washington. abadheka@everettclinic.com.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D016527:Drug Costs; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D023821:Limb Salvage; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D057216:Propensity Score; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: hospital mortality; peripheral vascular diseases; platelet aggregation inhibitors