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Propensity Score-Adjusted Comparison of Long-Term Outcomes Among Revascularization Strategies for Critical Limb Ischemia.
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2019 Sep; Vol. 12 (9), pp. e008097. Date of Electronic Publication: 2019 Sep 09. - Publication Year :
- 2019
-
Abstract
- Background: Few studies have compared long-term outcomes among specific treatment modalities for critical limb ischemia. The aim of this study was to compare long-term outcomes with percutaneous transluminal angioplasty (PTA), stent placement, atherectomy, or surgical bypass in patients diagnosed with critical limb ischemia.<br />Methods: In this observational study using Medicare claims data, we identified incident cases with a primary critical limb ischemia diagnosis who received PTA, stent placement, atherectomy, or surgical bypass. We used propensity score weighting to determine the association of treatment type with all-cause mortality and major (above ankle) amputation over 4 years follow-up.<br />Results: Among 36 860 patients (10 904 PTA; 11 295 stent placement; 4422 atherectomy; 10 239 surgical bypass), all-cause mortality over 4 years was 49.3% with atherectomy, 51.4% with surgical bypass, 53.7% with stent placement, and 54.7% with PTA (P<0.05 for all pairwise comparisons). Major amputation rates over 4 years were 6.8% with atherectomy, 7.8% with stent placement, 8.1% with PTA, and 10.8% with surgical bypass (P<0.05 for all pairwise comparison except PTA versus stent).<br />Conclusions: Among Medicare beneficiaries who received PTA, stent placement, atherectomy, or surgical bypass for critical limb ischemia, high mortality and major amputation rates were observed with minor differences among treatment groups. Statistically significant group differences of uncertain clinical importance were observed for several comparisons. Results from observational research may be susceptible to bias because of unmeasured confounders and, therefore, these comparative results should be interpreted with caution.
- Subjects :
- Administrative Claims, Healthcare
Aged
Aged, 80 and over
Amputation, Surgical
Critical Illness
Databases, Factual
Female
Humans
Ischemia diagnostic imaging
Ischemia mortality
Ischemia physiopathology
Limb Salvage
Male
Medicare
Peripheral Arterial Disease diagnostic imaging
Peripheral Arterial Disease mortality
Peripheral Arterial Disease physiopathology
Propensity Score
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome
United States
Angioplasty, Balloon adverse effects
Angioplasty, Balloon instrumentation
Angioplasty, Balloon mortality
Atherectomy adverse effects
Atherectomy mortality
Ischemia therapy
Peripheral Arterial Disease therapy
Vascular Grafting adverse effects
Vascular Grafting mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 12
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 31495219
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.119.008097