Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample

Karthik Vedantam; Christian A. Torres; Brad J. Martinsen; Marissa Donatelle; Malik Shehadeh; James D. Flaherty; Rajesh V. Swaminathan; Sunil Rao; Martin B. Leon; Ajay J. Kirtane; Nirat Beohar

doi:10.1016/j.carrev.2023.03.008

Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample

Karthik Vedantam, Christian A. Torres, Brad J. Martinsen, Marissa Donatelle, Malik Shehadeh, James D. Flaherty, Rajesh V. Swaminathan, Sunil Rao, Martin B. Leon, Ajay J. Kirtane, Nirat Beohar^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. Methods: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. Results: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. Conclusions: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.

Original language	English (US)
Pages (from-to)	13-19
Number of pages	7
Journal	Cardiovascular Revascularization Medicine
Volume	53
DOIs	https://doi.org/10.1016/j.carrev.2023.03.008
State	Published - Aug 2023

Funding

Data were obtained from NIS database from 2016 through 2019. The NIS is part of the Healthcare Cost and Utilization Project (HCUP) and sponsored by the Agency for Healthcare Research and Quality (AHRQ) created with federal, state, and industry partnerships [7]. It is the largest publicly available all-payer inpatient healthcare database in the United States (US), yielding national estimates of inpatient hospital outcomes. The NIS consists of a stratified sample of discharges from all hospitals in HCUP, equal to approximately 20 % of all discharges in US hospitals. Each hospitalization included in the database represents a unique observation and one primary discharge diagnosis and 29 secondary diagnoses during the index hospitalization along with epidemiological and socioeconomic variables. When weights (DISCWT) provided by the NIS database are utilized, it estimates >35 million hospitalizations per year nationally. Since the database contains de-identified patient information, the study was deemed exempt from the need for Institutional Review Board (IRB) approval by our institution.

Keywords

Aortic stenosis
Atherectomy
Outcomes
Percutaneous coronary intervention
Trends

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.carrev.2023.03.008

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Vedantam, K., Torres, C. A., Martinsen, B. J., Donatelle, M., Shehadeh, M., Flaherty, J. D., Swaminathan, R. V., Rao, S., Leon, M. B., Kirtane, A. J., & Beohar, N. (2023). Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample. Cardiovascular Revascularization Medicine, 53, 13-19. https://doi.org/10.1016/j.carrev.2023.03.008

@article{7f8eb12242944997998d8f339b382dbd,

title = "Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample",

abstract = "Background: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. Methods: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. Results: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 \%, 2.3 \%, and 9.1 \% were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts (\$34,340.77 in OA, \$32,306.2 in non-OA) as compared to the PCI-only cohort (\$23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. Conclusions: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.",

keywords = "Aortic stenosis, Atherectomy, Outcomes, Percutaneous coronary intervention, Trends",

author = "Karthik Vedantam and Torres, \{Christian A.\} and Martinsen, \{Brad J.\} and Marissa Donatelle and Malik Shehadeh and Flaherty, \{James D.\} and Swaminathan, \{Rajesh V.\} and Sunil Rao and Leon, \{Martin B.\} and Kirtane, \{Ajay J.\} and Nirat Beohar",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = aug,

doi = "10.1016/j.carrev.2023.03.008",

language = "English (US)",

volume = "53",

pages = "13--19",

journal = "Cardiovascular Revascularization Medicine",

issn = "1553-8389",

publisher = "Elsevier Inc.",

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Vedantam, K, Torres, CA, Martinsen, BJ, Donatelle, M, Shehadeh, M, Flaherty, JD, Swaminathan, RV, Rao, S, Leon, MB, Kirtane, AJ & Beohar, N 2023, 'Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample', Cardiovascular Revascularization Medicine, vol. 53, pp. 13-19. https://doi.org/10.1016/j.carrev.2023.03.008

TY - JOUR

T1 - Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis

T2 - 2016–2019 National Inpatient Sample

AU - Vedantam, Karthik

AU - Torres, Christian A.

AU - Martinsen, Brad J.

AU - Donatelle, Marissa

AU - Shehadeh, Malik

AU - Flaherty, James D.

AU - Swaminathan, Rajesh V.

AU - Rao, Sunil

AU - Leon, Martin B.

AU - Kirtane, Ajay J.

AU - Beohar, Nirat

PY - 2023/8

Y1 - 2023/8

N2 - Background: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. Methods: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. Results: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. Conclusions: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.

AB - Background: Patients with aortic stenosis (AS) usually have concomitant calcified coronary artery disease (CAD) requiring atherectomy to improve lesion compliance and odds of successful percutaneous coronary intervention (PCI). However, there is a paucity of data regarding PCI with or without atherectomy in patients with AS. Methods: The National Inpatient Sample (NIS) database was queried from 2016 through 2019 using ICD-10 codes to identify individuals with AS who underwent PCI with or without atherectomy (Orbital Atherectomy [OA], Rotational or Laser Atherectomy [non-OA]). Temporal trends, safety, outcomes, costs, and correlates of major adverse cardiovascular events (MACE) were assessed using discharge weighted data. Results: Hospitalizations of 45,420 AS patients undergoing PCI with or without atherectomy were identified and of those, 88.6 %, 2.3 %, and 9.1 % were treated with PCI-only, OA, or non-OA, respectively. There was an increase in PCIs (8855 to 10,885), atherectomy [OA (165 to 300) and non-OA (795 to 1255)], and intravascular ultrasound (IVUS) use (625 to 1000). The median cost of admission was higher in the atherectomy cohorts ($34,340.77 in OA, $32,306.2 in non-OA) as compared to the PCI-only cohort ($23,683.98). Patients tend to have decreased odds of MACE with IVUS guided atherectomy and PCI. Conclusions: This large database revealed a significant increase in PCI with or without atherectomy in AS patients from 2016 to 2019. Considering the complex comorbidities of AS patients, the overall complication rates were well distributed among the different cohorts, suggesting that IVUS guided PCI with or without atherectomy in patients with AS is feasible and safe.

KW - Aortic stenosis

KW - Atherectomy

KW - Outcomes

KW - Percutaneous coronary intervention

KW - Trends

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ER -

Percutaneous Coronary Intervention and Discretionary Atherectomy in Patients with Aortic Stenosis: 2016–2019 National Inpatient Sample

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ASJC Scopus subject areas

UN SDGs

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