Drug-eluting versus nondrug peripheral vascular interventions.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Health Outcomes Research

Background:

• Drug-eluting peripheral vascular interventions (PVIs) are recognized for superior patency rates compared to non-drug devices.
• Recent studies have raised concerns regarding the safety profile of drug-eluting devices in PVI procedures.

Purpose of the Study:

• To evaluate the in-hospital safety and efficacy of drug-eluting versus non-drug peripheral vascular interventions.
• To compare outcomes including mortality, length of stay, and procedural complications between the two PVI device types.

Main Methods:

• Utilized the 2016 Nationwide Readmissions Database, identifying 49,883 patients undergoing lower extremity arterial PVI.
• Employed propensity matching to adjust for baseline differences between patients receiving drug-eluting (25.3%) and non-drug (74.7%) devices.
• Assessed in-hospital outcomes such as mortality, acute kidney injury, amputation, bleeding, and vascular complications.

Main Results:

• Drug-eluting PVI was associated with significantly lower in-hospital mortality (2.2% vs. 2.9%) and shorter hospitalization (8.3 vs. 8.6 days) compared to non-drug PVI.
• Bleeding events were also reduced in the drug-eluting group (12.0% vs. 13.5%).
• No significant differences were observed in acute kidney injury, amputation, compartment syndrome, or vascular complications; the mortality benefit vanished after propensity matching.

Conclusions:

• While initial analysis suggested benefits of drug-eluting PVI, including reduced mortality and shorter hospital stays, these advantages were not sustained after propensity matching.
• The study indicates comparable safety profiles between drug-eluting and non-drug PVIs when accounting for patient characteristics.
• Further research is warranted to fully elucidate the long-term safety and efficacy of drug-eluting devices in peripheral vascular interventions.