Of Miami Miller School Of Medicine, United States; Jay Patel, Detroit. Medical .... Aquino, Icahn School of Medicine at Mount Sinai, United States; Usman. Baber ...
Abstracts Chothani, Medstar Institute, Washington Hospital Center, United States; Sidakpal Panaich, Detroit Medical Center, United States; Badal thakkar, Tulane School of Public Health and Tropical Medicine, United States; Samir Patel, Western Reserve Health System, United States; Chirag Savani, New York Medical College, United States; Nishit Patel, University Of Miami Miller School Of Medicine, United States; Jay Patel, Detroit Medical Center, United States; Abhishek Deshmukh, Mayo Clinic, United States; Sunny Jhamnani, Yale University School Of Medicine, United States; Apurva Badheka, Yale University School Of Medicine, United States Background: The impact of hospital volume on the length of stay (LOS) and cost of care following renal artery stenosis intervention not studied well. Methods: Using Nationwide In-patient Sample (NIS), we studied the trends in hospitalization cost and LOS in renal artery stenosis stent placement between 2001 – 11. Only patients > ¼ 18 years were included. Annual hospital volume was calculated using unique identification numbers every year and then divided into tertiles for analysis. Cost to charge ratio files were merged with NIS to calculate cost of care (adjusted for inflation in reference to 2011). LOS was calculated only in alive patients. Hierarchical mixed effects linear regression models were generated to adjust for confounding variables. Results: In total 18,355 procedures (weighted: 89,607) were identified (42.5% females and 62.7% whites). The average LOS was 2.13 0.03 days and cost was $11,893 63. As hospital volume increases hospital LOS and cost of care decrease (Figure). Multivariate analysis showed similar results with increased hospital volume: decrease in LOS (OR, 95% CI, p-value) (Days: Tertile 3: -0.74, -0.94 - -0.55, p < .0001; Tertile 2: -0.56, -0.71 - -0.40, p < 0.001); and cost of care (Tertile 3: -935 $, -1468- - 402, p ¼ 0.004; Tertile 2: -803 $, -1,215 - 391, p ¼ 0.01). Emergent/urgent admissions were associated with increase in LOS and cost of care, while CCI > ¼ 2 were associated with an increase in the cost of care. Conclusion: High hospital volumes for renal artery stent placement were associated with significant reduction in resource utilization in terms of Length of hospitalization and hospitalization cost. Disclosures: Shilpkumar Arora: This author has nothing to disclose. Kanishk Agnihotri: This author has nothing to disclose. Nileshkumar Patel: This author has nothing to disclose. Nilay Patel: This author has nothing to disclose. Sopan Lahewala: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Parshva Patel: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Ankit Chothani: This author has nothing to disclose. Sidakpal Panaich: This author has nothing to disclose. Badal thakkar: This author has nothing to disclose. Samir Patel: This author has nothing to disclose. Chirag Savani: This author has nothing to disclose. Nishit Patel: This author has nothing to disclose. Jay Patel: This author has nothing to disclose. Abhishek Deshmukh: This author has nothing to disclose. Sunny Jhamnani: This author has nothing to disclose. Apurva Badheka: This author has nothing to disclose.
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217 Title: LONG TERM FOLLOW UP OF EXTENDED LONG SIROLIMUS ELUTING STENTS OF INDIAN ORIGIN IN CORONARY ARTERY DISEASE Category: Stents (including DES) Authors: Rohit Manoj, PGIMER, CHANDIGARH, INDIA, India; Ramesh Patel, PGIMER, CHANDIGARH, INDIA, India; Parag Barwad, PGIMER, CHANDIGARH, INDIA, India Background: Drug eluting stents (DES) have become standard of care in treatment of coronary artery disease (CAD). The various sizes and lengths of DES that have been used routinely in clinical practice are 2.25 mm to 4.0 mm and 8 mm to 38 mm respectively. In longer lesions, many a times it becomes necessary to implant an overlapping stent which definitely increases the risk of restenosis. In this study we evaluated the efficacy of Indian made extended long sirolimus eluting stent (SES) of size 38 mm, 43mm and 48mm by angiographic followup of atleast one year. Methods: This study was conducted in Advanced Cardiac Center of postgraduate institute of medical sciences (PGIMER), Chandigarh, INDIA. Ethical approval was obtained for conduct of study by the institutional ethics committee. Results: From November 2011 to May 2014, 34 patient were implanted with 39 extended long SES. Mean age was 53.4 16 years. Indication for stenting was acute STEMI in 19 (55.8%), unstable angina or NSTEMI in 9 (26.6%) and 6 (17.6%) with chronic stable angina. Stent diameter ranged from 2.5 to 4.0 mm with mean of 3.0 0.32 mm and mean length of stent was 44.283.18 with 21 lesion deployed with 43 mm stents and 14 lesion with 48 mm stents. Mean follow up period was 15.76 4.98 months. Angiographic success was 100% and clinical success was 97%. One patient developed acute stent thrombosis on day 2 of stenting. Another patient at 9 months of stenting gave history suggestive of clinical restenosis and angiography showed complete occlusion of stented vessel. The patient was found to have poor compliance to DAPT. Four patient and 5 lesions had angiographic restenosis (>50% restenosis in stent) in 5 stented vessels and thus, instent restenosis (ISR) rate at the one year was 11.7%. All ISR were focal i.e, < 10 mm or of type I pattern. There was no reported death related to stent thrombosis or ISR. Target vessel revascularization (TVR) was done in 2 (5.8%) patient, one with acute stent thrombosis and another with ISR and clinical symptoms of angina. Conclusion: Extended long sirolimus eluting stents of Indian origin are effective and safe for treatment of long and diffuse coronary artery lesions. They led to better lesion cover without requirement of overlapping stent with acceptable rate of ISR and TVR.
Disclosures: Rohit Manoj: This author has nothing to disclose. Ramesh Patel: This author has nothing to disclose. Parag Barwad: This author has nothing to disclose.
218 Title: Association between stent length with contemporary stents and clinical outcomes: Results from a large volume single center experience Category: Stents (including DES) Authors: Jaya Chandrasekhar, Icahn School of Medicine at Mount Sinai, United States; Jason Kovacic, Mount Sinai Hospital, United States; Swathi Roy, Mount Sinai Hospital, United States; Melissa Aquino, Icahn School of Medicine at Mount Sinai, United States; Usman Baber, Icahn School of Medicine at Mount Sinai, United States; George Dangas, Mount Sinai Hospital, United States; Roxana Mehran, Icahn
Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
