米国における冠動脈再血管化の傾向,2001年~2008年
Andrew J Epstein1, Daniel Polsky, Feifei Yang
1Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA.
JAMA
|May 5, 2011
まとめ
冠動脈再循環率は著しく低下し,冠動脈バイパス移植 (CABG) 手術の利用率は減少したが,皮膚経冠動脈介入 (PCI) は2001年から2008年の間に米国の病院で安定したままでした.
科学分野:
- 心血管医学は,心臓血管医学である.
- 医療サービス 研究 医療サービス
- 介入性心臓病学 介入性心臓病学
背景:
- 冠動脈再血管化は,アメリカの病院でよく行われている手術です.
- 新技術,臨床試験の証拠,およびリバスカライゼーションの傾向に関するガイドラインの影響は不明である.
研究 の 目的:
- 冠動脈再血管化の割合と種類における国内動向を分析する.
- 冠動脈バイパス移植 (CABG) 手術および皮膚経冠動脈介入 (PCI) の利用における変化を調べる.
主な方法:
- 2001年から2008年にかけての米国の入院件数に関する連続的横断的研究.
- 医療費の利用と利用プロジェクトによる全国の入院患者サンプルとメディケア請求.
- CABG手術とPCIの年間処置率を分析した.
主要な成果:
- 冠動脈再血管化の総比率は,2001-2002年から2007-2008年にかけて15%減少した.
- 冠動脈バイパス移植 (CABG) の手術率は著しく減少したが,皮膚経冠動脈介入 (PCI) の率は安定した.
- CABG手術を行う病院の数は増加したが,病院あたりの平均症例数は減少し,より少ない処置を行う病院が増えた.
結論:
- 冠動脈バイパス移植 (CABG) 手術の利用率は,2001年から2008年の間に米国の病院で大幅に減少しました.
- 皮膚経冠動脈介入 (PCI) の利用率は,同じ期間に変わらなかった.
- 傾向は,再血管化戦略の転換を示唆し,PCI病院の可用性が増加したにもかかわらず,CABG手術の使用が減少しています.
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