TY - JOUR
T1 - Intravascular ultrasound, optical coherence tomography, and fractional flow reserve use in acute myocardial infarction
AU - Vallabhajosyula, Saraschandra
AU - El Hajj, Stephanie C.
AU - Bell, Malcolm R.
AU - Prasad, Abhiram
AU - Lerman, Amir
AU - Rihal, Charanjit S.
AU - Holmes, David R.
AU - Barsness, Gregory W.
N1 - Funding Information:
Dr. Saraschandra Vallabhajosyula is supported by the Clinical and Translational Science Award (CTSA) grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Funding Information:
Information regarding each discharge includes patient demographics, primary payer, hospital characteristics, principal diagnosis, up to 24 secondary diagnoses, and procedural diagnoses. The HCUP‐NIS does not capture individual patients, but captures all information for a given admission. Institutional Review Board approval was not sought due to the publicly available nature of this deidentified database. These data are available to other authors via the HCUP‐NIS database with the Agency for Healthcare Research and Quality. The National (Nationwide) Inpatient Sample (NIS) is the largest all‐payer database of hospital inpatient stays in the United States. NIS contains discharge data from a 20% stratified sample of community hospitals and is a part of the Healthcare Quality and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality. Coronary angiography (ICD‐9CM 36.06, 37.22, 37.23, 88.53–88.56), PCI (ICD‐9CM 00.66, 36.01, 36.02, 36.05, 36.07, 88.57), IVUS (ICD‐9CM 00.24), OCT (ICD‐9CM 38.24), and FFR (ICD‐9CM 00.59) were identified for all admissions. The Deyo's modification of the Charlson comorbidity index was used to identify the burden of comorbid diseases ( Supporting Information Table 1 Demographic characteristics, hospital characteristics, acute organ failure, mechanical circulatory support, noncardiac organ support use were identified for all admissions using previously used methodologies from our group. Using the HCUP‐NIS data from 2004 to 2014, a retrospective cohort study of admissions with AMI that underwent diagnostic coronary angiography were identified. AMI in the primary procedure field were identified using codes for ST‐elevation myocardial infarction (STEMI) (International Classification of Diseases 9.0 Clinical Modification [ICD‐9CM] 410.1x‐410.6x, 410.8x, 410.9x) and non‐ST‐elevation myocardial infarction (NSTEMI) (ICD‐9CM 410.70–410.79). ). The primary outcome was the temporal trends of IVUS, OCT, and FFR use during the 11‐year study period. Temporal trend analysis was further stratified by patient characteristics, hospital demographics, and type of AMI. Secondary outcomes included inhospital mortality, length of stay, hospitalization costs, and discharge disposition in admissions with and without IVUS, OCT, and FFR use.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95% confidence interval 0.50–0.56]), more frequent discharges to home (83.7% vs. 76.8%), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.
AB - Background: There are limited data on the use of intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) during acute myocardial infarction (AMI). Objectives: To assess the temporal trends of IVUS, OCT, and FFR use in AMI. Methods: A retrospective cohort study from the National Inpatient Sample (2004–2014) was designed to include AMI admissions that received coronary angiography. Administrative codes were used to identify percutaneous coronary intervention (PCI), IVUS, OCT, and FFR. Outcomes included temporal trends, inhospital mortality and resource utilization stratified by IVUS, OCT, or FFR use. Results: In 4,419,973 AMI admissions, IVUS, OCT, and FFR were used in 2.6%, 0.1%, and 0.6%, respectively. There was a 22-fold, 118-fold, and 33-fold adjusted increase in IVUS, OCT, and FFR use, respectively, in 2014 compared to the first year of use. Non-ST-elevation AMI presentation, male sex, private insurance coverage, admission to a large urban hospital, and absence of cardiac arrest and cardiogenic shock were associated with higher IVUS, OCT, or FFR use. PCI was performed in 83.2% of the IVUS, OCT, or FFR cohort compared to 64.2% of the control group (p <.001). The cohort with IVUS/OCT/FFR use had lower inhospital mortality (adjusted odds ratio 0.53 [95% confidence interval 0.50–0.56]), more frequent discharges to home (83.7% vs. 76.8%), shorter hospital stays (4.3 ± 4.4 vs. 5.0 ± 5.5 days) and higher hospitalization costs ($90,683 ± 74,093 vs. $74,671 ± 75,841). Conclusions: In AMI, the use of IVUS, OCT, and FFR has increased during 2004–2014. Significant patient and hospital-level disparities exist in the use of these technologies.
KW - acute myocardial infarction
KW - fractional flow reserve
KW - intravascular ultrasound
KW - optical coherence tomography
KW - percutaneous coronary intervention
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U2 - 10.1002/ccd.28543
DO - 10.1002/ccd.28543
M3 - Article
C2 - 31724274
AN - SCOPUS:85075420661
SN - 1522-1946
VL - 96
SP - E59-E66
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -