Incidence and in-hospital outcomes of single-vessel coronary chronic total occlusion treated with percutaneous coronary intervention

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:269

Article

Doshi, Rajkumar¹  Patel, Nirav²  Kalra, Rajat³  Arora, Harpreet²  Bajaj, Navkaranbir S.^2,4,5,6  Arora, Garima²  Arora, Pankaj^2,7 

[1] Univ Nevada, Reno Sch Med, Dept Internal Med, 1155 Mill St,W-11, Reno, NV 89502 USA

[2] Univ Alabama Birmingham, Div Cardiovasc Dis, 1900 Univ Blvd, Birmingham, AL 35233 USA

[3] Univ Minnesota, Cardiovasc Div, 420 Delaware St SE, Minneapolis, MN 55455 USA

[4] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[5] Brigham & Womens Hosp, Dept Radiol, 75 Francis St, Boston, MA 02115 USA

[6] Harvard Med Sch, 75 Francis St, Boston, MA 02115 USA

[7] Birmingham Vet Affairs Med Ctr, Sect Cardiol, 1720 2nd Ave South, Birmingham, AL 35294 USA

关键词: Chronic total occlusion;    Coronary artery disease;    Epidemiology;    Percutaneous coronary intervention;   

DOI  :  10.1016/j.ijcard.2018.07.075

来源: Elsevier

【 摘 要 】

Background: Coronary chronic total occlusion (CTO) using percutaneous coronary intervention (PCI) presents a distinct challenge in the field of cardiology owing to multiple reasons including the increased risk of periprocedural complications. We sought to explore rates of hospitalization, outcomes, use of mechanical circulatory support devices, and economic burden associated with single-vessel coronary CTO undergoing PCI for stable coronary artery disease (CAD). Methods: The National Inpatient Sample spanning from 2008 through 2014 was queried to identify hospitalizations associated with single-vessel coronary CTO-PCI for stable CAD by excluding hospitalizations with ST-elevation and non-ST elevation myocardial infarction. Survey-Specific logistic regression was used to analyze adjusted incidence of in-hospital mortality and acute renal failure. Results: A total of 109,094 hospitalizations were identified as having single-vessel coronary CTO-PCI for stable CAD from 2008 to 2014. An increasing number of coronary CTO-PCI hospitalizations (2465 to 2688 per 100,000 PCI procedures, P-trend < 0.001) with an overall in-hospital mortality of 0.5% was observed. The rate of in-hospital mortality remained unchanged (P-trend = 0.13), but an increasing rate of acute renal failure was observed in the multivariate-adjusted analysis (P-trend < 0.001). Furthermore, a rise in the utilization of intraaortic balloon pumps and percutaneous left ventricular assist devices during single-vessel coronary CTO-PCI was noted. Taken together, these may account for increasing costs of hospitalization for single-vessel coronary CTO-PCI ($13,909 in 2008 to $17,729 in 2014, P-trend < 0.001). Conclusion: In a large retrospective study, slightly increased rates of single-vessel coronary CTO-PCI for stable CAD were observed. This is accompanied by a rise in morbidity and growing healthcare costs. (c) 2018 Elsevier B.V. All rights reserved.

【 授权许可】

Free