Intravascular Ultrasound Imaging During Aortoiliac Stenting: No Impact on Outcomes at 1 Year

2020 ◽  
pp. 152660282094987 ◽  
Author(s):  
Takuya Tsujimura ◽  
Mitsuyoshi Takahara ◽  
Osamu Iida ◽  
Yasutaka Yamauchi ◽  
Yoshiaki Shintani ◽  
...  
Keyword(s):  
Propensity Score ◽  
Clinical Outcomes ◽  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Propensity Score Analysis ◽  
Treatment Strategies ◽  
Fluoroscopy Time ◽  
Restenosis Rate ◽  
Intravascular Ultrasound Imaging ◽  
Propensity Score Matching Analysis

Purpose To investigate the effect of intravascular ultrasound (IVUS) imaging use on clinical outcomes after aortoiliac stenting in patients with peripheral artery disease (PAD). Materials and Methods Subjects for this retrospective analysis were derived from the OMOTENASHI registry database, which contained 803 symptomatic PAD patients (Rutherford categories 2–4) who were treated with self-expanding stent implantation for aortoiliac atherosclerotic lesions at 61 centers in Japan between January 2014 and April 2016. Of the 803 patients, 545 (67.9%) patients (mean age 73±9 years; 453 men) underwent IVUS-supported stent implantation and were compared with the 258 patients (mean age 73±8 years; 217 men) treated without IVUS. A propensity score analysis of 138 matched pairs was conducted to compare treatment strategies and clinical outcomes between patients having IVUS-supported endovascular therapy and those treated without IVUS. Results Endovascular strategies and postoperative medications were not significantly different between the IVUS and no-IVUS groups. A procedure time under 1 hour was less frequent in the IVUS group, which had a longer fluoroscopy time. The 12-month restenosis rate was not significantly different between the 2 groups [10.2% (95% CI 6.9 to 14.9%) vs 10.3% (95% CI 5.4 to 18.6%), p=0.99]. There was no interaction between baseline characteristics and the association of IVUS use with restenosis risk. Conclusion Propensity score matching analysis revealed that duration and fluoroscopy time during IVUS-supported procedures were significantly longer than in cases without IVUS use, whereas the 12-month restenosis rate was not significantly different between the groups. IVUS use in aortoiliac lesions may be unnecessary.

P4704The efficacy of intravascular ultrasound for patients with peripheral artery diseases presenting aorto-iliac artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tsujimura ◽  
O Iida ◽  
M Takahara ◽  
Y Yamauchi ◽  
Y Shintani ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Primary Patency ◽  
Peripheral Artery ◽  
Baseline Characteristics ◽  
Artery Disease ◽  
The Impact

Abstract Background The use of intravascular ultrasound (IVUS) promotes better clinical outcomes for intervention in complex lesions. However, the data demonstrating whether use of IVUS improves primary patency following stenting for aorto-iliac lesions in patients with peripheral artery disease (PAD) are limited. Purpose The purpose of the current study was to investigate the impact of IVUS use on primary patency 12 months after stent implantation for aorto-iliac lesions. Methods We analyzed a clinical database of the OMOTENASHI registry (Observational prospective Multicenter registry study on Outcomes of peripheral arTErial disease patieNts treated by AngioplaSty tHerapy in aortoIliac artery), registering symptomatic PAD patients (Rutherford category 2, 3, or 4) undergoing endovascular therapy for aorto-iliac lesions between January 2014 and April 2016 in Japan. The current study analyzed 803 patients who underwent self-expandable stent implantation at 61 centers with the institutional volume known. The primary endpoint was 12-month restenosis, defined as ≥50% stenosis on computed tomography or angiography, or a peak systolic velocity ratio ≥2.5 on duplex ultrasound. When treatment strategies, endovascular procedures and clinical outcomes were compared between the patients treated with IVUS use and those treated without IVUS use, the propensity score matching was performed to minimize the inter-group difference in baseline characteristics. Results A total of 545 patients (67.9%) underwent IVUS-supported stent implantation. Patients treated with IVUS use had a lower prevalence of regular dialysis, whereas they had a higher prevalence of TASC II class D and chronic total occlusion. In patients treated with IVUS use, carbon dioxide contrast agent were more often used, and 0.035-inch guidewire was less frequently selected. Implanted stents in these patients were longer and smaller in diameter. The propensity score matching extracted 138 pairs, with no remarkable intergroup difference in baseline characteristics. Procedure time ≤1 hour was less frequent in patients treated with IVUS use; their radiation time was longer. Endovascular strategies, as well as postoperative medication were not significantly different between patients with and without IVUS use. The 12-month restenosis risk was not significantly different between patients with and without IVUS use (10.2% [6.9 to 14.9%] versus 10.3% [5.4 to 18.6%], P=0.99). Conclusion IVUS use in aorto-iliac stenting for patients with PAD was not associated with primary patency at 12 months. Acknowledgement/Funding None

scholarly journals Impact of β-Lactam and Daptomycin Combination Therapy on Clinical Outcomes in Methicillin-susceptible Staphylococcus aureus Bacteremia: A Propensity Score–matched Analysis

2019 ◽  
Vol 69 (9) ◽  
pp. 1480-1488 ◽  
Author(s):  
Sara Grillo ◽  
Guillermo Cuervo ◽  
Jordi Carratalà ◽  
Immaculada Grau ◽  
Natàlia Pallarès ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Tertiary Hospital ◽  
Propensity Score Matching Analysis ◽  
Staphylococcus Aureus Bacteremia

Abstract Background Mortality rates from Staphylococcus aureus bacteremia are high and have only modestly improved in recent decades. We compared the efficacies of a β-lactam in combination with daptomycin (BL/D-C) and β-lactam monotherapy (BL-M) in improving clinical outcomes in methicillin-susceptible S. aureus (MSSA) bacteremia. Methods A retrospective cohort study of MSSA bacteremia was performed in a tertiary hospital from January 2011 to December 2017. Patients receiving BL/D-C and BL-M were compared to assess 7-, 30-, and 90-day mortality rates. A 1:2 propensity score matching analysis was performed. Differences were assessed using Cox regression models. Results Of the 514 patients with MSSA bacteremia, 164 were excluded as they had received combination therapies other than BL/D-C, had pneumonia, or died within 48 hours of admission. Of the remaining 350 patients, 136 and 214 received BL/D-C and BL-M, respectively. BL/D-C patients had higher Pitt scores and persistent bacteremia more often than BL-M patients. In the raw analysis, there were no differences in mortality rates between groups. After propensity score matching, there were no significant differences between the BL/D-C (110 patients) and BL-M (168 patients) groups for all-cause mortality rates at 7 days (8.18% vs 7.74%; P = 1.000), 30 days (17.3% vs 16.1%; P = .922), and 90 days (22.7% vs 23.2%; P = 1.000), even in a subanalysis of patients with high-risk source of infection and in a subgroup excluding catheter-related bacteremia. Conclusions BL/D-C failed to reduce mortality rates in patients with MSSA bacteremia. Treatment strategies to improve survival in MSSA bacteremia are urgently needed.

scholarly journals Reducing Morbidity in Urgent Gastroenterologic Surgery; Propensity Score Analysis Using Triclosan-Coated Polydioxanone Sutures

2017 ◽  
Vol 102 (1-2) ◽  
pp. 58-63
Author(s):  
Shinsuke Takeno ◽  
Kanefumi Yamashita ◽  
Tomoaki Noritomi ◽  
Seichiro Hoshino ◽  
Yasushi Yamauchi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Propensity Score Matching Analysis ◽  
Abdominal Closure

Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P = 0.043); wound classification (P = 0.0005); peritonitis (P = 0.019); prolonged operation time (P = 0.0001); increased blood loss (P = 0.019); transfusion (P = 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P = 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P = 0.20), but it tended to be associated with a shorter hospital stay (P = 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.

Association between angiographic and intravascular ultrasound optimizations after new-generation drug-eluting stent implantation and clinical outcomes

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jung-Joon Cha ◽  
Daehoon Kim ◽  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
Chul-Min Ahn ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Drug Eluting ◽  
New Generation

scholarly journals Clinical outcomes of carbapenem de-escalation regardless of microbiological results: A propensity score analysis

2019 ◽  
Vol 85 ◽  
pp. 80-87 ◽  
Author(s):  
Svetlana Sadyrbaeva-Dolgova ◽  
Pilar Aznarte-Padial ◽  
Juan Pasquau-Liaño ◽  
Manuela Expósito-Ruiz ◽  
Miguel Ángel Calleja Hernández ◽  
...  
Keyword(s):  
Propensity Score ◽  
Clinical Outcomes ◽  
Propensity Score Analysis ◽  
Score Analysis

P5362Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y H Kim ◽  
A.-Y Her ◽  
M H Jeong ◽  
B.-K Kim ◽  
S.-Y Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Statin Therapy ◽  
Clinical Outcomes ◽  
Stent Implantation ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
St Segment Elevation ◽  
St Segment

Abstract Background Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI). Purpose The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES. Methods Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n=15002) and the NSTEMI group (n=11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period. Results After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n=15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p=0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1). Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value STEMI NSTEMI Log-rank Propensity score matched patients MACE 532 (7.2) 584 (8.1) 0.092 1.106 (0.984–1.244) 0.092 All-cause death 163 (2.2) 224 (3.1) 0.001 1.386 (1.133–1.696) 0.002 Cardiac death 121 (1.5) 148 (2.0) 0.088 1.232 (0.969–1.566) 0.089 Re-MI 117 (1.6) 107 (1.5) 0.545 0.922 (0.710–1.199) 0.545 Total revascularization 291 (4.1) 307 (4.4) 0.422 1.068 (0.910–1.254) 0.423 TLR 92 (1.3) 89 (1.2) 0.880 0.978 (0.731–1.309) 0.880 TVR 173 (2.4) 184 (2.6) 0.478 1.078 (0.876–1.327) 0.478 Non-TVR 123 (1.7) 130 (1.9) 0.593 1.070 (0.836–1.369) 0.539 Conclusion The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.

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