TCT-480 National Trend in Multivessel Percutaneous Coronary Intervention in Patients with Diabetes Mellitus in the United States

Abstract available through the Journal of the American College of Cardiology

National Trend in Multivessel Percutaneous Coronary Intervention in Patients with Diabetes Mellitus in the United States

Patients with diabetes and multivessel coronary artery disease treated with multivessel percutaneous coronary intervention (MVPCI) have higher mortality, non-fatal myocardial infarction and repeat revascularization rates compared to coronary artery bypass graft surgery (CABG). This is also associated with high hospital costs. The objective of our study was to assess and compare the proportions and trends 2016 Appalachian Student Research Forum Page 83 of MVPCI in diabetic and all PCI patients and the total charges associated with them. Data were retrieved from nationwide inpatient sample from 2006-2011, which is a 20% stratified probability sample of discharges in all community hospitals participating in Healthcare Cost and Utilization Project. International Classification of Diseases 9 codes were used to identify diabetic patients who underwent percutaneous coronary intervention with stents in two or more vessels. Patients with a history CABG surgery, cardiac transplant and those who were below 18 years of age were excluded from this study. Bivariate analyses were computed for demographics and various diagnosis and procedures. Trends were computed for the proportions of diabetic and all patients that received stents in single, 2 or more and 3 or more vessels and for total charges for the 24 quarters. Between 2006 and 2011, a total of 145,349 diabetic patients underwent single vessel PCI with a mean age of 63.96 ± 11.70, 40.9% females and 59.1% males. 41,325 diabetic patients underwent = 2 vessels PCI, mean age 64.63 ± 11.64, 39.1% females and 60.9% males. 2,406 diabetic patients underwent = 3 vessels with a mean age of 64.92 ± 11.81 and 38.5% females and 61.5% males. The mean total charges for all single vessel PCI patients for the period was on a steady rise with a mean of $51,584.06 in the 1st quarter 2006 and$77,075.88 in the 24th quarter, 2011. Likewise, the trend for =2 vessel PCI group steadily increased from a mean of $61,089 to$91,937 and those for =3 vessel PCI group up from $73,532.08 to$105,364 through the period. For the diabetic PCI patients, charges associated with the single vessel PCI were on the upward trend with a mean of $53,217 in the 1st quarter to$81,040 in the 24th quarter. Similarly, the mean total charges associated with =2 vessel diabetic PCI group increased from $62,442 to$93,427 and from $78,401 to$110,015 for the =3 vessel diabetic PCI group across the period. There was a steady increase in the total charges for both single vessel and MVPCI procedures performed on diabetic and all patients between 2006 and 2011. The results of this study can be used to assess health care delivery cost and to inform policy to reduce cost

WUnicuspid Aortic Valve- An Uncommon Anomaly With a Common Presentation

Unicuspid aortic valve (UAV), which is a rare congenital anomaly, usually presents as aortic stenosis and/or aortic regurgitation. Here we present a case of UAV co-existent with an ascending aortic aneurysm. A 26-year-old male with no significant past medical history presented to the hospital after two episodes of syncope. Transthoracic echocardiogram showed an ejection fraction of 62%, severely stenotic aortic valve, and moderate aortic regurgitation. Computed tomography revealed calcification of the aortic valve, compatible with aortic stenosis and aneurysm of the ascending aorta measuring 4.3 cm in diameter. He underwent successful aortic valve replacement and repair of ascending aortic aneurysm. He recovered well without any complications. This case suggests that any young patient who presents with syncope, aortic stenosis would be a differential and further workup by any available non-invasive modality needs to be performed

National Trend in Multivessel Percutaneous Coronary Intervention in Patients with Diabetes Mellitus in the United States

Abstract available through the Journal of the American College of Cardiology