Author + information
- Katherine Bailey1,
- Aditya Mantha2,
- Esteban Aguayo3,
- Young-Ji Seo1,
- Vishal Dobaria4,
- Yen-Yi Juo5,
- Peyman Benharash5 and
- Ramin Ebrahimi6
- 1David Geffen School of Medicine at UCLA, Los Angeles, California, United States
- 2University of California Irvine, Orange, California, United States
- 3UCLA/CDU School of Medicine, Los Angeles, California, United States
- 4UCLA, Los Angeles, California, United States
- 5David Geffen School of Medicine at UCLA, LOS ANGELES, California, United States
- 6David Geffen School of Medicine UCLA & Veteran's Administration, Los Angeles, California, United States
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are established as effective therapies for patients with ischemic heart disease. However, there is insufficient literature comparing the impact of revascularization approach on readmissions, resource utilization, and mortality in patients with autoimmune vascular disorders.
All patients who underwent percutaneous coronary intervention and/or coronary artery bypass grafting in the 2010-2014 National Readmission Database (NRD) were considered for analysis. The NRD is an all-payer inpatient database maintained by the Healthcare Cost and Utilization Project (HCUP) that estimates more than 35 million annual U.S. hospitalizations. The primary outcomes were 30-day readmission, mortality, length of stay, and GDP-adjusted cost. A hierarchical linear model adjusting for socioeconomic, demographic and comorbidity measured by Elixhauser Comorbidity Index was used to adjust for baseline differences.
Of the 3,003 total patients with autoimmune vasculitis, 2,259 (75%) underwent PCI and 744 patients had CABG during the study period. PCI patients were more likely female (53 vs 39%, p<0.001) and had lower Elixhauser Comorbidity Index (4.7 vs 5.3, p<0.01). PCI approach was associated with significantly lower overall cost ($26,658 vs $54,208, p<0.001) and a shorter length of stay (5.8 vs 13 days, p<0.001). There was no significant difference in cost for readmission within 30 days ($11,362 vs $15,400, p=NS), length of stay for readmission within 30 days (5.9 vs 6.5 days IRR:1.00, p=NS), all-cause readmission (20% vs 15% OR:1.24 p=NS), or mortality (3.2% vs 5.3%, OR:0.99, p=NS) between the two approaches.
In this short follow up study of 3,003 U.S. patients with autoimmune vasculitis and ischemic heart disease, PCI approach was associated with significant reduction in cost and length of stay compared to CABG after adjustment for demographics, comorbidities, and hospital level variation. Our findings indicate that PCI may be a suitable and cost-conscious approach to patients with autoimmune vasculitides.
CORONARY: PCI Outcomes