Aortic & peripheral vascular diseaseCohort study
Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia
- Retrospective cohort study
Marginal Cox regression adjusted for patient-level covariates
Authors' conclusion
This study showed large interhospital variability in revascularization strategies, as well as improved outcomes for patients receiving endovascular treatment at higher volume sites.
Study context
- Population
- Medicare beneficiaries ≥66 years with chronic limb-threatening ischemia (CLTI) treated at US institutions offering both strategies, October 1, 2015 to December 31, 2021
- Participants
- 196,070 beneficiaries · 1,832 institutions
- Exposure
- Endovascular vs Surgical bypass
Main finding
As reported in the abstract
Interhospital variation in endovascular treatment use
Endovascular
82.5%
- Adjusted median OR for receiving an endovascular procedure among hospitals (Q1-Q3: 2.24-2.40; P < 0.01)
- 2.32
Observational data: associations, not effects.
Further findings
Major amputation and repeat procedures, endovascular at highest-quintile hospitals
| Comparison | aHR (95% CI) | P value | |
|---|---|---|---|
| Endovascular · major amputation, highest quintile hospitals | 0.82 (0.77–0.88) | P < 0.01 | |
| Endovascular · repeat procedures, highest quintile hospitals | 1.37 (1.32–1.43) | P < 0.01 | |
| 0.512Adjusted hazard ratio (log scale) |
Major amputation and repeat procedures, surgical bypass at highest-quintile hospitals
| Comparison | aHR (95% CI) | P value | |
|---|---|---|---|
| Surgical bypass · major amputation, highest quintile hospitals | 1.21 (1.13–1.29) | P < 0.01 | |
| Surgical bypass · repeat procedures, highest quintile hospitals | 0.73 (0.70–0.76) | P < 0.01 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia. JACC Cardiovasc Interv. Published 8 January 2025. doi:10.1016/j.jcin.2024.09.024
Summarised from the published abstract; every number is checked against it