Study Evaluates Outcomes and Costs of Peripheral Angioplasty Versus Endovascular Stenting for PAD

June 10, 2015—Findings from a comparison of in-hospital outcomes and hospitalization costs of peripheral angioplasty and endovascular stenting for the treatment of peripheral arterial disease (PAD) were published by Sidakpal S. Panaich, MD, et al online ahead of print in the American Journal of Cardiology. The investigators concluded that endovascular stenting is associated with a lower rate of postprocedural complications, lower amputation rates, and only minimal increase in hospitalization costs compared to angioplasty alone.

The investigators noted that the comparative data for angioplasty and stenting for treatment of PAD is largely limited to technical factors such as patency rates, with sparse data on clinical outcomes such as mortality, postprocedural complications, and amputation. 

As summarized in the American Journal of Cardiology, the study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database between the years 2006 and 2011. Peripheral endovascular interventions were identified using appropriate ICD-9 diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The primary outcome included in-hospital mortality; secondary outcome was a composite of in-hospital mortality and postprocedural complications. Amputation was a separate outcome. Hospitalization costs were also assessed.

Endovascular stenting was found to be independently predictive of a lower composite endpoint of in-hospital mortality and postprocedural complications when compared to angioplasty alone, as well as lower amputation rates with no significant difference in terms of in-hospital mortality alone. Multivariate analysis also revealed stenting to be predictive of higher hospitalization costs (+$1,516) compared to angioplasty, reported the investigators in the American Journal of Cardiology.