Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006-2011).

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 88(4):605-616, 2016 OctPMID: 26914274Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational StudySubject headings: *Endovascular Procedures | *Lower Extremity/bs [Blood Supply] | *Peripheral Arterial Disease/th [Therapy] | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | *Platelet Glycoprotein GPIIb-IIIa Complex/ai [Antagonists & Inhibitors] | Adolescent | Adult | Aged | Aged, 80 and over | Amputation | Cross-Sectional Studies | Databases, Factual | Drug Costs | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/ec [Economics] | Endovascular Procedures/mo [Mortality] | Female | Hospital Costs | Hospital Mortality | Humans | Limb Salvage | Logistic Models | Male | Middle Aged | Multivariate Analysis | Odds Ratio | Peripheral Arterial Disease/di [Diagnosis] | Peripheral Arterial Disease/ec [Economics] | Peripheral Arterial Disease/mo [Mortality] | Platelet Aggregation Inhibitors/ae [Adverse Effects] | Platelet Aggregation Inhibitors/ec [Economics] | Propensity Score | Risk Factors | Time Factors | Treatment Outcome | United States | Young AdultYear: 2016Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: There is paucity of data regarding the impact of GPI on the outcomes following peripheral endovascular interventions.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.Copyright © 2016 Wiley Periodicals, Inc.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.OBJECTIVE: The aim of our study was to study the impact of glycoprotein IIb/IIIa inhibitors (GPI) on in-hospital outcomes.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 (All authors: Arora S, Attaran RR, Badheka AO, Bhatt P, Chothani A, Cleman M, Curtis JP, Deshmukh A, Forrest JK, Grines C, Jhamnani S, Lahewala S, Mena CI, Mohamad T, Panaich SS, Patel A, Patel J, Patel N, Patel N, Patel NJ, Patel S, Remetz MS, Savani C, Schreiber T, Singh V, Sonani R, Thakkar B, Tripathi BFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26914274 Available 26914274

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: There is paucity of data regarding the impact of GPI on the outcomes following peripheral endovascular interventions.

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.

Copyright © 2016 Wiley Periodicals, Inc.

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.

OBJECTIVE: The aim of our study was to study the impact of glycoprotein IIb/IIIa inhibitors (GPI) on in-hospital outcomes.

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 ( 1,091+/-404 vs. 19,407+/-133, P<0.001).

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