Gender disparities among patients with peripheral arterial disease treated via endovascular approach: A propensity score matched analysis

AbstractA recent meta-analysis addressed increased risk of death following revascularization with paclitaxel-coated devices in femopopliteal artery. We evaluated differences in all-cause mortality and amputation free survival between peripheral arterial disease (PAD) patients who were treated with paclitaxel-coated devices and non-paclitaxel-coated devices. This was retrospective population-based cohort study from the National Health Insurance Service claims in South Korea from 2015 to 2019. Multivariate Cox regression analyses after propensity score matching were applied to identify all-cause mortality and amputation-free survival. After propensity score matching, there were 6090 patients per group. The median follow-up days was 580 days (interquartile range [IQR] 240–991 days) and 433 days (IQR 175–757 days) for the non-paclitaxel-coated device group and paclitaxel-coated device group, respectively. Multivariate analysis adjusted for age, sex, diabetes, hypertension, warfarin, and new oral anticoagulants showed that the mortality rate associated with paclitaxel-coated devices was not significantly higher than non-paclitaxel-coated devices (hazard ratio [HR] 0.992; 95% CI 0.91–1.08). The rate of amputation events was higher in patients with paclitaxel-coated devices than those with non-paclitaxel-coated devices (HR 1.614; 95% CI 1.46–1.78). In this analysis, the mortality rate in patients with PAD was not associated with the use of paclitaxel-coated devices, despite a higher amputation rate.

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Abstract 12428: Efficacy of a Risk Reduction Program to Improve Cardiovascular Outcomes in Patients With Peripheral Arterial Disease: A Propensity Score-Matched Study

Circulation ◽

10.1161/circ.132.suppl_3.12428 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mohamad A Hussain ◽

Mohammed Al-Omran ◽

Muhammad Mamdani ◽

Xuesong Wang ◽

Subodh Verma ◽

...

Keyword(s):

Risk Factor ◽

High Risk ◽

Propensity Score ◽

Peripheral Arterial Disease ◽

Risk Reduction ◽

Primary Outcome ◽

Arterial Disease ◽

Reduction Program ◽

Peripheral Arterial

Introduction: Patients with peripheral arterial disease (PAD) are often undertreated for cardiovascular (CV) risk factors, and they are at high risk for CV events. Hypothesis: A program that focuses on guideline-based risk factor management reduces adverse CV and limb events in PAD patients. Methods: A propensity-score matched observational cohort study with up to 7 years of follow-up was conducted using administrative databases in Ontario, Canada. Symptomatic PAD patients that were enrolled in the Systematic Assessment of Vascular Risk (SAVR) program between July 2004 and April 2007 were matched with up to 2 (control) patients with PAD from other Ontario tertiary vascular centers not enrolled in the program. The primary outcome was a composite of death, stroke or myocardial infarction (MI). Secondary outcomes included lower limb amputation and revascularization procedures. Cox proportional hazards regression analysis was used to compare outcomes between the groups. Results: A total of 791 patients were studied. During follow-up, the SAVR group (n=290) experienced the primary outcome at a significantly lower rate than the control group (adjusted HR, 0.64 [95% CI, 0.52 to 0.78]; P<0.001) (Figure). SAVR patients were also less likely to undergo major amputation (adjusted HR, 0.47 [95% CI, 0.29 to 0.77]; P=0.002), minor amputation (adjusted HR, 0.26 [95% CI, 0.13 to 0.54]; P<0.001), arterial bypass surgery (adjusted HR, 0.47 [95% CI, 0.30 to 0.73]; P<0.001), and less likely to have a hospitalization due to heart failure (adjusted HR, 0.73 [95% CI, 0.53 to 0.998]; P=0.048). The rate of peripheral angioplasty was higher among the SAVR group (adjusted HR, 3.0 [95% CI, 2.2 to 4.1]; P<0.001). Conclusions: A multifactor risk reduction program targeted to patients with PAD is associated with fewer adverse CV and limb events over the long-term. Greater focus is needed on developing structured programs for risk factor control in these high-risk patients.

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Amputation-free survival in patients with diabetic foot ulcer and peripheral arterial disease: Endovascular versus open surgery in a propensity score adjusted analysis

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2020.107551 ◽

2020 ◽

Vol 34 (5) ◽

pp. 107551 ◽

Cited By ~ 4

Author(s):

Talha Butt ◽

Erika Lilja ◽

Targ Elgzyri ◽

Jan Apelqvist ◽

Anders Gottsäter ◽

...

Keyword(s):

Propensity Score ◽

Peripheral Arterial Disease ◽

Diabetic Foot ◽

Open Surgery ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Free Survival ◽

Adjusted Analysis ◽

Peripheral Arterial

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Efficacy of a Risk Reduction Program to Improve Cardiovascular Outcomes in Patients With Peripheral Arterial Disease: A Propensity Score-Matched Study

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.08.036 ◽

2015 ◽

Vol 62 (5) ◽

pp. 1380-1381

Author(s):

Mohamad A. Hussain ◽

Mohammed Al-Omran ◽

Muhammad Mamdani ◽

Xuesong Wang ◽

Subodh Verma ◽

...

Keyword(s):

Propensity Score ◽

Peripheral Arterial Disease ◽

Risk Reduction ◽

Arterial Disease ◽

Cardiovascular Outcomes ◽

Reduction Program ◽

Peripheral Arterial ◽

Matched Study

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Utilization and in-hospital outcomes associated with atherectomy in the treatment of peripheral vascular disease: An observational analysis from the National Inpatient Sample

Vascular ◽

10.1177/1708538118760135 ◽

2018 ◽

Vol 26 (5) ◽

pp. 464-471 ◽

Cited By ~ 1

Author(s):

Rajkumar Doshi ◽

Evan Shlofmitz ◽

Perwaiz Meraj

Keyword(s):

Length Of Stay ◽

Propensity Score ◽

Peripheral Arterial Disease ◽

Hospital Mortality ◽

Arterial Disease ◽

Arterial Calcification ◽

National Inpatient Sample ◽

Hospital Outcomes ◽

Percutaneous Revascularization ◽

Peripheral Arterial

Objective Percutaneous revascularization for patients with peripheral arterial disease has become a treatment of choice for many symptomatic patients. The presence of severe arterial calcification presents many challenges for successful revascularization. Atherectomy is an adjunctive treatment option for patients with severe calcification undergoing percutaneous intervention. We sought to analyze the impact of atherectomy on in-hospital outcomes, length of stay, and cost in the percutaneous treatment of peripheral arterial disease. Methods Patients with lower extremity peripheral arterial disease undergoing percutaneous revascularization were assessed, utilizing the National Inpatient Sample (2012–2014) and appropriate International Classification of Diseases, 9th Revision, Clinical Modification diagnostic and procedural codes. Patients who were not treated with atherectomy ( n = 51,037) were compared to those treated with atherectomy ( n = 11,408). Propensity score-matched analysis was performed to address baseline differences. Results After performing propensity score-matched analysis, 11,037 patients were included in each group. Utilization of atherectomy was associated with lower in-hospital mortality (2% vs. 1.4% p = 0.0006). All secondary outcomes were lower when using atherectomy except acute renal failure. Length of stay was slightly lower when using atherectomy (7.2 vs. 7.0 days, p = 0.0494). However, median cost was higher in patients treated with atherectomy ($21,589 vs. $24,060, p = <0.0001). Conclusion The use of atherectomy was associated with significantly decreased in-hospital mortality, adverse events, and length of stay. Though, cost associated with atherectomy use is increased, this is offset by decreased in-hospital adverse outcomes. Appropriate use of atherectomy devices is an important tool in revascularization of peripheral arterial disease in select patients.

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