PMID- 35075941
OWN - NLM
STAT- MEDLINE
DCOM- 20230124
LR  - 20230201
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 30
IP  - 1
DP  - 2023 Feb
TI  - Underutilization of Drug-Eluting Stents in Infrapopliteal Intervention for 
      Chronic Limb-Threatening Ischemia.
PG  - 45-56
LID - 10.1177/15266028211068763 [doi]
AB  - PURPOSE: Multiple randomized clinical trials have shown superiority of 
      drug-eluting stents (DES) over bare-metal stents (BMS) for infrapopliteal 
      disease. However, real-world data on DES utilization and outcomes in 
      infrapopliteal chronic limb-threatening ischemia (CLTI) patients are unknown. 
      MATERIALS AND METHODS: We utilized the Nationwide Readmission Database (NRD) from 
      2016 to 2017 to extract patients undergoing infrapopliteal intervention with 
      stents (BMS and DES) for CLTI using appropriate ICD-10 codes. Multilevel logistic 
      regression with hospital ID as random effect was used to assess DES utilization. 
      Primary outcome was the composite of target limb major amputation (TLmajA) and 
      target limb revascularization (TLR). Multivariate Cox-proportional hazard 
      regression was used to adjust for confounders. RESULTS: Our study included a 
      total of 1817 patients. Of these patients, 1056 patients (58.1%) received DES; 
      DES utilization was stable (relative change: +2.5%, p-trend: 0.867) between 2016 
      and 2017 and was higher in teaching hospitals (adjusted odds ratio [aOR] = 1.28, 
      95% CI = 1.03-1.61, p=0.029] and medium (aOR = 3.13, 95% CI = 2.17-4.55, p</=0.001) 
      and large (aOR = 1.56, 95% CI = 1.14-2.17, p=0.005) bed-sized hospitals. 
      Inter-class correlation was 0.44 suggesting ~44% variation in DES utilization 
      between any 2 random hospitals; DES was associated with lower rate of the primary 
      composite outcome (aHR = 0.75, 95% CI = 0.62-0.92, p=0.004) compared with BMS. 
      CONCLUSION: In patients undergoing infrapopliteal intervention for CLTI, DES 
      demonstrated significant underutilization despite supportive evidence of their 
      superiority compared with BMS; DES was associated with improvement in the primary 
      composite outcome compared with BMS.
FAU - Zuzek, Zachary
AU  - Zuzek Z
AUID- ORCID: 0000-0002-4472-8613
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Arora, Shilpkumar
AU  - Arora S
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Helmy, Irfan
AU  - Helmy I
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Jani, Chinmay
AU  - Jani C
AD  - Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
FAU - Jaswaney, Rahul
AU  - Jaswaney R
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Patel, Kirtenkumar
AU  - Patel K
AD  - North Shore University Hospital, Manhasset, NY, USA.
FAU - Patel, Harsh P
AU  - Patel HP
AD  - Louis A. Weiss Memorial Hospital, Chicago, IL, USA.
FAU - Patel, Mohini
AU  - Patel M
AD  - Boston University School of Public Health, Boston, MA, USA.
FAU - Osman, Mohammed Najeeb
AU  - Osman MN
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Li, Jun
AU  - Li J
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
FAU - Shishehbor, Mehdi H
AU  - Shishehbor MH
AUID- ORCID: 0000-0002-4888-2431
AD  - Harrington Heart and Vascular Institute, Case Western Reserve University School 
      of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve 
      University, Cleveland, OH, USA.
LA  - eng
PT  - Journal Article
DEP - 20220125
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Humans
MH  - *Drug-Eluting Stents
MH  - Chronic Limb-Threatening Ischemia
MH  - Treatment Outcome
MH  - Risk Factors
MH  - *Peripheral Arterial Disease/diagnostic imaging/therapy
MH  - Stents
OTO - NOTNLM
OT  - angioplasty
OT  - chronic limb-threatening ischemia
OT  - drug-eluting stent
OT  - nationwide readmissions database
EDAT- 2022/01/26 06:00
MHDA- 2023/01/25 06:00
CRDT- 2022/01/25 08:46
PHST- 2022/01/26 06:00 [pubmed]
PHST- 2023/01/25 06:00 [medline]
PHST- 2022/01/25 08:46 [entrez]
AID - 10.1177/15266028211068763 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2023 Feb;30(1):45-56. doi: 10.1177/15266028211068763. Epub 2022 
      Jan 25.