冠動脈再循環の適切な使用基準と利用の傾向,患者の選択,および皮膚経冠動脈介入の適切性
Nihar R Desai1, Steven M Bradley2, Craig S Parzynski3
1Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
JAMA
|November 10, 2015
まとめ
冠動脈再循環のための適切な使用基準は,非緊急の皮膚経冠動脈介入 (PCI) 処置の減少につながった. 不適切なPCIの使用は減少したが,病院間の差異は依然として存在し,最適な患者の選択における継続的な課題を強調している.
科学分野:
- 心血管医学
- 医療サービス研究
- 介入心臓科
背景:
- 冠動脈再循環のための適切な使用基準は,皮膚経冠動脈介入 (PCI) の患者の選択を導くために確立されました.
- これらの基準に従ってPCIの適性に関する国々の傾向は十分に文書化されていない.
研究 の 目的:
- 適切な使用基準の実施後のPCI利用と患者の選択の傾向を分析する.
- PCIの手続きの妥当性の変化を時間とともに評価する.
主な方法:
- 2009年から2014年にかけての270万件のPCI手続の多センター縦断分析が行われました.
- データは,国立心血管データレジストリ (CathPCI) のレジストリから得られた.
- 不適切と分類された非急性PCIの割合は,2012年の適切な使用基準を用いて評価された.
主要な成果:
- 非急性PCIの量は著しく減少したが,急性PCIの量は安定した.
- 非急性PCIを受けた患者は,胸痛の重症度が増加し,処置前の薬の使用が増加しました.
- 不適切な非急性PCIの割合は26. 2パーセントから13. 3パーセントに減少し,絶対的な数は相応に減少した.
結論:
- 適切な使用基準は,非急性PCI量および不適切な使用の有意な減少と関連しています.
- 整体的な改善にもかかわらず,不適切なPCIの割合は病院レベルでの大幅な変動が続いている.
- 医療施設全体で適切なPCI利用を標準化するためにさらなる努力が必要です.
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