Variation in Atherectomy Practice Patterns in Asian Patients Is Driven by Procedure Setting

The prevalence of peripheral arterial disease in Asian patients is increasing and often of calcific nature. We aimed to examine differences in atherectomy practice patterns between White and Asian patients and whether this varies with procedure setting. We analyzed the Vascular Quality Initiative Peripheral Vascular Intervention dataset from 2014-2021. We divided regions into quartiles based on ambulatory surgery center/office-based laboratory (ASC/OBL) procedure density. The primary outcome was atherectomy use, and we also examined differences in distal protection device use, procedure setting, uninsured status, and late outcomes. Propensity scores were used to match White and Asian patients based on age, sex, comorbidities, and lesion characteristics. Logistic and Cox regressions were performed within the matched cohort. A total of 134,958 White and 1907 Asian patients underwent peripheral vascular intervention and we identified 2212 patients in the matched cohort. On adjusted analysis, while overall atherectomy rate was similar between groups (22%), atherectomy rate was significantly higher in Asian patients within areas of highest ASC/OBL procedure density (55% vs 34%; P < .001). Distal protection device use during atherectomy was lower in Asian patients overall (15% vs 23%; P = .022), which was also driven by areas of highest ASC/OBL use (2.4% vs 25%; P < .001). Logistic regression demonstrated that Asian race was associated with twofold greater odds of atherectomy and decreased odds of distal protection device use, which was driven by high ASC/OBL procedure density regions (Table). Asian race was associated with greater odds of care at ASC/OBLs overall, and particularly in areas of high ASC/OBL procedure density. While Asian patients were more likely to be uninsured overall, this was not demonstrated in highest ASC/OBL use regions. The 1-year primary and secondary patency, reintervention, and amputation rates did not differ between groups. Compared with White patients, Asian patients are more likely to undergo atherectomy and less likely to receive distal protection devices, which is driven by a tendency to undergo care at ambulatory or office-based settings despite similar rates of uninsured status in high ASC/OBL regions. These results highlight the need to understand differences in referral patterns leading to atherectomy use in Asian patients.TableLogistic regression analysis of outcomes within propensity-matched cohortAssociation with Asian raceOR (95% CI)P valueAtherectomy1.0 (0.8-1.2).918 Highest quartile ASC/OBL procedure density2.3 (1.5-3.6)<.001Distal protection device0.6 (0.4-0.9).023 Highest quartile ASC/OBL procedure density0.1 (0.0-0.3).001Atherectomy performed at ASC/OBL2.7 (2.0-3.6)<.001 Highest quartile ASC/OBL procedure density6.0 (3.7-9.8)<.001Uninsured status2.8 (1.3-6.2).008 Highest quartile ASC/OBL procedure density0.6 (0.1-7.1).717ASC/OBL, Ambulatory surgery center/office-based laboratory; CI, confidence interval; OR, odds ratio.Boldface entries indicate statistical significance. Open table in a new tab