Temporal Trends and Outcomes of Peripheral Artery Disease... : Critical Pathways in Cardiology (original) (raw)

Original Study

Temporal Trends and Outcomes of Peripheral Artery Disease and Critical Limb Ischemia in the United States

Krittanawong, Chayakrit MD, FACC*; Imoh, Kimberly MD†; Ang, Song Peng MD‡; Qadeer, Yusuf Kamran MD§; Virk, Hafeez Ul Hassan MD, FACC, RPVI¶; Alam, Mahboob MD, FACC∥; Lavie, Carl J MD, FACC**; Sharma, Raman MD, FACC, RPVI††

From the *Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY

†Division of Internal Medicine, Baylor College of Medicine, TX

‡Division of Internal Medicine, Rutgers Health/Community Medical Center, NJ

§Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, MI

¶Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH

∥The Texas Heart Institute, Baylor College of Medicine, Houston, TX

**John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA

††Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, Mount Sinai Heart, New York, NY.

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Reprints: Chayakrit Krittanawong, MD, FACC, Cardiology Division, NYU School of Medicine, 550 First Avenue, New York, NY 10016. E-mail: [email protected].

Abstract

Introduction:

Peripheral artery disease (PAD) is a progressive, systemic atherosclerotic disease that is associated with an increased risk of coronary artery disease, cerebrovascular disease, and critical limb ischemia (CLI). CLI represents the most severe stage of PAD, characterized by progressive endothelial dysfunction and arterial narrowing. We hypothesized that the incidence of CLI and PAD would increase over the study period and that the rates of in-hospital mortality and major amputations among patients admitted with CLI would rise correspondingly.

Methods:

We utilized the National Inpatient Sample database from 2016 to 2021 using the International Classification of Disease, Tenth Edition, Clinical Modification codes. Patients with primary or secondary diagnoses of PAD were initially selected, and subsequently hospitalization with CLI was appropriately identified. The Cochran Armitage test was used to describe the trend of outcomes across the years. All statistical analyses were conducted using the software Stata version 17.0.

Results:

From 2016 to 2021, there were 2,930,639 admissions for CLI. Up to 65% of these patients were over the age of 60, and 35.8% of these patients were women. Most of these individuals were white (64.7%), followed by African Americans (15.8%) and Hispanics (12.6%). In-hospital mortality rates varied by revascularization method, with hybrid revascularization showing the highest rate at 2.6%, followed by endovascular revascularization at 1.8%, and surgical revascularization at 1.6%. Additionally, hospitalization costs were highest for patients undergoing hybrid revascularization ($46,257 ± 36,417),comparedwithendovascular(36,417), compared with endovascular (36,417),comparedwithendovascular(36,924 ± 27,945)andsurgicalrevascularization(27,945) and surgical revascularization (27,945)andsurgicalrevascularization(35,672 ± $27,127). Endovascular revascularization rates seemed to increase while surgical revascularization rates decreased during this time period.

Conclusions:

PAD is a progressive, systemic atherosclerotic disease that is associated with an increased risk of coronary artery disease, cerebrovascular disease, and CLI. Our data showed that the rates of PAD and CLI hospitalizations have remained relatively stable from 2016 to 2021, but there seems to be a trend toward doing more revascularization via an endovascular approach as compared to a surgical approach.