Author/Authors :
Badheka، نويسنده , , Apurva O. and Arora، نويسنده , , Shilpkumar and Panaich، نويسنده , , Sidakpal S. and Patel، نويسنده , , Nileshkumar J. and Patel، نويسنده , , Nilay and Chothani، نويسنده , , Ankit N Mehta، نويسنده , , Kathan and Deshmukh، نويسنده , , Abhishek and Singh، نويسنده , , Vikas and Savani، نويسنده , , Ghanshyambhai T. and Agnihotri، نويسنده , , Kanishk and Grover، نويسنده , , Peeyush and Lahewala، نويسنده , , Sopan and Patel، نويسنده , , Achint and bambhroliya، نويسنده , , Chirag and Kondur، نويسنده , , Ashok and Brown، نويسنده , , Michael and Elder، نويسنده , , Mahir and Kaki، نويسنده , , Amir and Mohammad، نويسنده , , Tamam and Grines، نويسنده , , Cindy and Schreiber، نويسنده , , Theodore، نويسنده ,
Abstract :
Contemporary large-scale data, regarding in-hospital outcomes depending on the types of stent used for percutaneous coronary intervention (PCI) is lacking. We queried the Healthcare Cost and Utilization Projectʹs Nationwide Inpatient Sample from 2006 to 2011 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 36.06 (bare-metal coronary artery stent, BMS) or 36.07 (drug-eluting coronary artery stent, DES) for PCI. All analyses were performed using the designated weighting specified to the Nationwide Inpatient Sample database to minimize bias. Primary outcome was in-hospital mortality. Waldʹs chi-square test was used for categorical variables. We built a hierarchical 2 level model adjusted for multiple confounding factors, with hospital identification incorporated as random effects in the model and propensity match analyses were used to adjust confounding variables. A total of 665,804 procedures were analyzed, which were representative of 3,277,884 procedures in the United States. Use of bare-metal stents (BMS) was associated with greater occurrence of in-hospital mortality compared with that of drug-eluting stents (DES; 1.4% vs 0.5%, p <0.001). The association stayed significant after adjustment of various possible confounding factors (odds ratio for DES versus BMS 0.59 [0.54 to 0.64, p <0.001]) and also in propensity matched cohorts (1.2% vs 0.7%, p <0.001). The results continued to be similar in the following high-risk subgroups: diabetes (0.57 [0.50 to 0.64, <0.001]), acute myocardial infarction and/or shock (0.53 [0.49 to 0.57, <0.001]), age >80 (0.66 [0.58 to 0.74, <0.001]), and multivessel PCI (0.55 [0.46 to 0.66, <0.001]). In conclusion, DES use was associated with lesser in-hospital mortality compared with BMS. This outcome benefit was seen across subgroups in various subgroups including elderly, diabetics, and acute myocardial infarction as well as multivessel interventions.
