Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006–2011)
Shilpkumar Arora MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Authors share equal contribution to this manuscript.
Search for more papers by this authorSidakpal S. Panaich MD
Borgess Medical Center, Kalamazoo, Michigan
Authors share equal contribution to this manuscript.
Search for more papers by this authorNilay Patel MD
Saint Peter's University Hospital, New Brunswick, New Jersey
Search for more papers by this authorNileshkumar J. Patel MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorSopan Lahewala MD
Jersey City Medical Center, Jersey City, New Jersey
Search for more papers by this authorBadal Thakkar MD
Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
Search for more papers by this authorSunny Jhamnani MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorVikas Singh MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorNish Patel MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorRajesh Sonani MD
Public Health Department, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorAchint Patel MD
Icahn School of Medicine at Mount Sinai, New York
Search for more papers by this authorByomesh Tripathi MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Search for more papers by this authorAbhishek Deshmukh MD
Mayo Clinic, Rochester, Minnesota
MedStar Washington Hospital Center, Washington, DC
Search for more papers by this authorAnkit Chothani MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Search for more papers by this authorParth Bhatt MD
Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
Search for more papers by this authorMichael S. Remetz MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorJeptha P. Curtis MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorRamak R. Attaran MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorCarlos I. Mena MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorTheodore Schreiber MD
Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorMichael Cleman MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorJohn K. Forrest MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorCorresponding Author
Apurva O. Badheka MD FACP CCDS RPVI
The Everett Clinic, Everett, Washington
Correspondence to: Apurva O. Badheka, MD FACP CCDS RPVI; The Everett Clinic, 3901 Hoyt Ave, Everett, WA 98201. E-mail: [email protected]Search for more papers by this authorShilpkumar Arora MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Authors share equal contribution to this manuscript.
Search for more papers by this authorSidakpal S. Panaich MD
Borgess Medical Center, Kalamazoo, Michigan
Authors share equal contribution to this manuscript.
Search for more papers by this authorNilay Patel MD
Saint Peter's University Hospital, New Brunswick, New Jersey
Search for more papers by this authorNileshkumar J. Patel MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorSopan Lahewala MD
Jersey City Medical Center, Jersey City, New Jersey
Search for more papers by this authorBadal Thakkar MD
Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
Search for more papers by this authorSunny Jhamnani MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorVikas Singh MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorNish Patel MD
University of Miami Miller School of Medicine, Miami, Florida
Search for more papers by this authorRajesh Sonani MD
Public Health Department, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorAchint Patel MD
Icahn School of Medicine at Mount Sinai, New York
Search for more papers by this authorByomesh Tripathi MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Search for more papers by this authorAbhishek Deshmukh MD
Mayo Clinic, Rochester, Minnesota
MedStar Washington Hospital Center, Washington, DC
Search for more papers by this authorAnkit Chothani MD
Mount Sinai St. Luke's Roosevelt Hospital, New York
Search for more papers by this authorParth Bhatt MD
Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
Search for more papers by this authorMichael S. Remetz MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorJeptha P. Curtis MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorRamak R. Attaran MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorCarlos I. Mena MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorTheodore Schreiber MD
Detroit Medical Center, Detroit, Michigan
Search for more papers by this authorMichael Cleman MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorJohn K. Forrest MD
Yale School of Medicine, New Haven, Connecticut
Search for more papers by this authorCorresponding Author
Apurva O. Badheka MD FACP CCDS RPVI
The Everett Clinic, Everett, Washington
Correspondence to: Apurva O. Badheka, MD FACP CCDS RPVI; The Everett Clinic, 3901 Hoyt Ave, Everett, WA 98201. E-mail: [email protected]Search for more papers by this authorAbstract
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.
Supporting Information
Additional Supporting Information may be found in the online version of this article.
| Filename | Description |
|---|---|
| ccd26452-sup-0001-suppinfo1.docx23.1 KB | Supporting Information |
| ccd26452-sup-0002-suppinfo2.docx84.6 KB | Supporting Information |
| ccd26452-sup-0003-suppinfo3.docx20.5 KB | Supporting Information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Hirsch AT, Hartman L, Town RJ, Virnig BA. National health care costs of peripheral arterial disease in the Medicare population. Vasc Med 2008; 13: 209–215.
- 2 Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 2004; 110: 738–743.
- 3 Peacock JM, Keo HH, Duval S, Baumgartner I, Oldenburg NC, Jaff MR, Henry TD, Yu X, Hirsch AT. The incidence and health economic burden of ischemic amputation in Minnesota, 2005–2008. Prev Chronic Dis 2011; 8: A141
- 4 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45: S5–S67.
- 5 Stangl PA, Lewis S. Review of currently available GP IIb/IIIa inhibitors and their role in peripheral vascular interventions. Semin Intervent Radiol 2010; 27: 412–421.
- 6 Quality AfHRa. 2008.Healthcare Cost and Utilization Project (HCUP). July 2008. Rockville: HCUP Databases.
- 7 Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: An overview. Eff Clin Pract 2002; 5: 143–151.
- 8 Whalen D, Houchens R, A E. 2004 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. HCUP Methods Series Report # 2007-03 Online.: U.S. Agency for Healthcare Research and Quality. 2007.
- 9 Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001–2008. Jama 2011; 305: 1769–1776.
- 10 Eslami MH, Csikesz N, Schanzer A, Messina LM. Peripheral arterial interventions: Trends in market share and outcomes by specialty, 1998–2005. J Vasc Surg 2009; 50: 1071–1078.
- 11 Nowygrod R, Egorova N, Greco G, Anderson P, Gelijns A, Moskowitz A, McKinsey J, Morrissey N, Kent KC. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006; 43: 205–216.
- 12 Lo RC, Bensley RP, Dahlberg SE, Matyal R, Hamdan AD, Wyers M, Chaikof EL, Schermerhorn ML. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease. J Vasc Surg 2014; 59: 409–418 e3.
- 13 Vogel TR, Dombrovskiy VY, Haser PB, Graham AM. Evaluating preventable adverse safety events after elective lower extremity procedures. J Vasc Surg 2011; 54: 706–713.
- 14 McDonald KM, Romano PS, Geppert J, Davies SM, Duncan BW, Shojania KG, Hansen A. Measures of Patient Safety Based on Hospital Administrative Data—The Patient Safety Indicators; 2002 Aug Safety Indicators. Rockville (MD): Agency for Healthcare Research and Quality (US). AHRQ Technical Reviews.
- 15 Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, Grover P, Singh V, Vallurupalli S, Savani GT, and others. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: Analysis of 93 801 procedures. Circulation 2013; 128: 2104–2112.
- 16 Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45: 613–619.
- 17 Tetteroo E, van der Graaf Y, Bosch JL, van Engelen AD, Hunink MG, Eikelboom BC, Mali WP. Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group. Lancet 1998; 351: 1153–1159.
- 18 Brunt ME, Egorova NN, Moskowitz AJ. Propensity score-matched analysis of open surgical and endovascular repair for type B aortic dissection. Int J Vasc Med 2011; 2011: 364046
- 19 Safavi KC, Li SX, Dharmarajan K, Venkatesh AK, Strait KM, Lin H, Lowe TJ, Fazel R, Nallamothu BK, Krumholz HM. Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes. JAMA Intern Med 2014; 174: 546–553.
- 20 Dorffler-Melly J, Mahler F, Do DD, Triller J, Baumgartner I. Adjunctive abciximab improves patency and functional outcome in endovascular treatment of femoropopliteal occlusions: initial experience. Radiology 2005; 237: 1103–1109.
- 21 Stone GW, Clayton T, Deliargyris EN, Prats J, Mehran R, Pocock SJ. Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding: The HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction). J Am Coll Cardiol 2014; 63: 15–20.
- 22 Iida O, Nakamura M, Yamauchi Y, Kawasaki D, Yokoi Y, Yokoi H, Soga Y, Zen K, Hirano K, Suematsu N, and others. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv 2013; 6: 68–76.
- 23 Mao CT, Tsai ML, Wang CY, Wen MS, Hsieh IC, Hung MJ, Wang CH, Chen CC, Chen TH. Outcomes and characteristics of patients undergoing percutaneous angioplasty followed by below-knee or above-knee amputation for peripheral artery disease. PLoS One 2014; 9: e111130
- 24 Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, and others. Peripheral arterial disease detection, awareness, and treatment in primary care. Jama 2001; 286: 1317–1324.
- 25 Tepe G, Schott U, Erley CM, Albes J, Claussen CD, Duda SH. Platelet glycoprotein IIb/IIIa receptor antagonist used in conjunction with thrombolysis for peripheral arterial thrombosis. Am J Roentgenol 1999; 172: 1343–1346.
- 26 Duda SH, Tepe G, Luz O, Ouriel K, Dietz K, Hahn U, Pereira P, Marsalek P, Ziemer G, Erley CM, and others. Peripheral artery occlusion: treatment with abciximab plus urokinase versus with urokinase alone—a randomized pilot trial (the PROMPT Study). Platelet Receptor Antibodies in Order to Manage Peripheral Artery Thrombosis. Radiology 2001; 221: 689–696.
- 27 Ansel GM, Silver MJ, Botti CF,J, Rocha-Singh K, Bates MC, Rosenfield K, Schainfeld RM, Laster SB, Zander C. Functional and clinical outcomes of nitinol stenting with and without abciximab for complex superficial femoral artery disease: a randomized trial. Catheter Cardiovasc Interv 2006; 67: 288–297.
- 28 Hanna EB, Rao SV, Manoukian SV, Saucedo JF. The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes. JACC Cardiovasc Interv 2010; 3: 1209–1219.
- 29 Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg 2010; 51: 230–241.
- 30 Shammas NW, Shammas GA, Jerin M, Dippel EJ, Shammas AN. In-hospital safety and effectiveness of bivalirudin in percutaneous peripheral interventions: Data from a real-world registry. J Endovasc Ther 2010; 17: 31–36.
- 31 Sheikh IR, Ahmed SH, Mori N, Gupta A, Mewissen M, Allaqaband S, Bajwa T. Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in percutaneous peripheral intervention: A single-center experience. JACC Cardiovasc Interv 2009; 2: 871–876.
