Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis
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Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis : Editor's Choice. / Behrendt, Christian-Alexander; Sedrakyan, Art; Peters, Frederik; Kreutzburg, Thea; Schermerhorn, Marc; Bertges, Daniel J; Larena-Avellaneda, Axel; L'Hoest, Helmut; Kölbel, Tilo; Debus, Eike Sebastian.
In: EUR J VASC ENDOVASC, Vol. 59, No. 4, 08.04.2020, p. 587-596.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis
T2 - Editor's Choice
AU - Behrendt, Christian-Alexander
AU - Sedrakyan, Art
AU - Peters, Frederik
AU - Kreutzburg, Thea
AU - Schermerhorn, Marc
AU - Bertges, Daniel J
AU - Larena-Avellaneda, Axel
AU - L'Hoest, Helmut
AU - Kölbel, Tilo
AU - Debus, Eike Sebastian
N1 - Copyright © 2019 The Author(s). Published by Elsevier B.V. All rights reserved.
PY - 2020/4/8
Y1 - 2020/4/8
N2 - OBJECTIVE: The aim of this study was to determine the survival of patients after use of paclitaxel coated devices (PCX), as a recent meta-analysis of randomised trials reported higher mortality in patients treated with PCX balloons and stents METHODS: A retrospective health insurance claims analysis of patients covered by the second largest insurance fund in Germany, BARMER, was used to identify index femoropopliteal arterial interventions between 1 January 2010 and 31 December 2018. To ensure first PCX exposure, patients with prior deployment of PCX were excluded. The study cohort was stratified into patients with chronic limb threatening ischaemia (CLTI) and intermittent claudication (IC), then into balloons vs. stents cohorts. Within each stratum PCX were compared with uncoated devices. Propensity score matching was used to balance the study groups. Survival was evaluated using the Kaplan-Meier method and Cox regression.RESULTS: There were 37 914 patients (mean age 73.3 years; 48.8% female) included in the study. The annual proportion of PCX use increased from 3% to 39% during the study period for CLTI and from 4% to 48% for IC (both p < .001). Paclitaxel coated balloons and stents were associated with improved overall survival (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77-0.90), amputation free survival (HR 0.85, 95% CI 0.78-0.91), and freedom from major cardiovascular events (HR 0.82, 95% CI 0.77-0.89) vs. uncoated devices at five years for CLTI. In IC cohort, mortality was significantly lower after using drug coated balloons (DCB) (HR 0.87, 95% CI 0.76-0.99) or combined DCB and drug eluting stents (HR 0.88, 95% CI 0.80-0.98).CONCLUSION: In this large health insurance claims analysis, rapid adoption of PCX, higher long term survival, better amputation free survival, and lower rates of major cardiovascular events were seen after their use for the treatment of CLTI.
AB - OBJECTIVE: The aim of this study was to determine the survival of patients after use of paclitaxel coated devices (PCX), as a recent meta-analysis of randomised trials reported higher mortality in patients treated with PCX balloons and stents METHODS: A retrospective health insurance claims analysis of patients covered by the second largest insurance fund in Germany, BARMER, was used to identify index femoropopliteal arterial interventions between 1 January 2010 and 31 December 2018. To ensure first PCX exposure, patients with prior deployment of PCX were excluded. The study cohort was stratified into patients with chronic limb threatening ischaemia (CLTI) and intermittent claudication (IC), then into balloons vs. stents cohorts. Within each stratum PCX were compared with uncoated devices. Propensity score matching was used to balance the study groups. Survival was evaluated using the Kaplan-Meier method and Cox regression.RESULTS: There were 37 914 patients (mean age 73.3 years; 48.8% female) included in the study. The annual proportion of PCX use increased from 3% to 39% during the study period for CLTI and from 4% to 48% for IC (both p < .001). Paclitaxel coated balloons and stents were associated with improved overall survival (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77-0.90), amputation free survival (HR 0.85, 95% CI 0.78-0.91), and freedom from major cardiovascular events (HR 0.82, 95% CI 0.77-0.89) vs. uncoated devices at five years for CLTI. In IC cohort, mortality was significantly lower after using drug coated balloons (DCB) (HR 0.87, 95% CI 0.76-0.99) or combined DCB and drug eluting stents (HR 0.88, 95% CI 0.80-0.98).CONCLUSION: In this large health insurance claims analysis, rapid adoption of PCX, higher long term survival, better amputation free survival, and lower rates of major cardiovascular events were seen after their use for the treatment of CLTI.
KW - Aged
KW - Aged, 80 and over
KW - Cardiovascular Agents/therapeutic use
KW - Constriction, Pathologic/etiology
KW - Female
KW - Femoral Artery/drug effects
KW - Humans
KW - Intermittent Claudication/mortality
KW - Ischemia/mortality
KW - Male
KW - Middle Aged
KW - Paclitaxel/therapeutic use
KW - Peripheral Arterial Disease/mortality
KW - Retrospective Studies
KW - Vascular Access Devices/statistics & numerical data
U2 - 10.1016/j.ejvs.2019.12.034
DO - 10.1016/j.ejvs.2019.12.034
M3 - SCORING: Journal article
C2 - 31926836
VL - 59
SP - 587
EP - 596
JO - EUR J VASC ENDOVASC
JF - EUR J VASC ENDOVASC
SN - 1078-5884
IS - 4
ER -
