Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel-Coated Devices: Insights From the Veterans Health Administration.
Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel-Coated Devices: Insights From the Veterans Health Administration.
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DOI：
10.1161/jaha.120.018149
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发表时间：
2021-02-16
影响因子：
5.4
通讯作者：
Swaminathan RV
中科院分区：
文献类型：
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作者：
Gutierrez JA;Rao SV;Jones WS;Secemsky EA;Aday AW;Gu L;Schulteis RD;Krucoff MW;White R;Armstrong EJ;Banerjee S;Tsai S;Patel MR;Swaminathan RV
紫杉醇涂层器械（PCD;药物涂层球囊或药物洗脱支架）用于外周血管内介入的长期安全性尚不确定。我们使用退伍军人健康管理局的数据来评价PCD、长期死亡率和死亡原因之间的关联。使用退伍军人管理局企业数据仓库结合国际疾病分类第十版（ICD-10）程序编码系统、当前程序术语和医疗保健通用程序编码系统代码，我们确定了2015年10月1日至2019年6月30日期间在退伍军人管理局接受股腘动脉血运重建治疗的外周动脉疾病患者。使用稳定的逆概率加权估计值进行校正的考克斯回归，以评价PCD与长期生存率之间的相关性。死因数据使用国家死亡指数获得。总计10505例患者接受股腘外周血管内介入治疗; 2265例（21.6%）使用PCD，8240例（78.4%）使用非PCD（经皮血管成形术球囊和/或裸金属支架）。PCD和非PCD组的2年（77.4% vs 79.7%）和3年（70.7% vs 71.8%）生存率分别相似。接受PCD治疗的患者与接受非PCD治疗的患者的全因死亡率的调整后危险为1.06（95% CI，0.95-1.18，P=0.3013）。在2015年10月1日至2017年12月31日期间死亡的患者中，根据治疗组，PCD与非PCD的死亡原因相似。在退伍军人管理局健康管理局内接受股腘外周血管内介入治疗的患者中，未发现与PCD使用相关的长期全因死亡风险增加。治疗组之间的特定原因死亡率相似。
The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision (ICD‐10) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P=0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.