経皮冠動脈介入後のオペレータ・ボリュームと長期的な結果の関係
Alexander C Fanaroff1,2, Pearl Zakroysky2, Daniel Wojdyla2
1Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.
Circulation
|December 28, 2018
まとめ
経皮冠動脈干渉 (PCI) のオペレータ用量の増加は,高齢者の入院死亡率の低下と関連しています. しかし,重症冠動脈疾患 (MACE) のような長期的なアウトカムでは,リスク調整後に有意な差異は見られなかった.
科学分野:
- 心血管医学
- 医療サービス研究
背景:
- 経皮冠動脈干渉 (PCI) の後の短期的な結果に影響することが知られている.
- オペレーターPCIの量と長期の患者のアウトカムとの関連はほとんど不明です.
- この関係を理解することは 患者のケアと処置の質を最適化するために重要です
研究 の 目的:
- 65歳以上の患者の経皮冠動脈干渉 (PCI) 量と長期的なアウトカムとの関連を調査する.
- 年間PCI量に基づいて事業者を層分けし,患者の死亡率と主要な不良冠動脈事件 (MACE) に対する影響を分析する.
- PCI後の長期の患者の健康状態の改善または低下と関連しているかどうかを判断する.
主な方法:
- メディケアの請求データとリンクされた 国立心血管データレジストリ (CathPCI) を利用した.
- 8,936人の事業者を低 (<50),中等 (50-100),および高 (>100) の年間PCI量カテゴリーに分類した.
- カプラン- メイヤーおよび比例リスクモデルを用いて,調整されていないおよびリスク調整された1年死亡率およびMACE (死亡,心筋梗塞再入院,または計画外再血管化) を計算した.
主要な成果:
- 2009年7月から2014年12月までの間に,合計72万3644件のPCI手続きが分析されました.
- 低容量のオペレータは,より多くの緊急PCIを行い,併発症の少ない患者を治療しました.
- リスク調整後,中量および高容量の操作者は,低容量の操作者と比較して,病院での死亡率が有意に低かったが,1年後のMACEでは有意な違いは観察されなかった.
結論:
- PCIでのオペレータ用量の増加は,高齢者の入院死亡率の減少と関連しています.
- 病院からの退院から1年間のフォローアップまでの異なるオペレータ・ボリューム・グループでは,重篤な冠動脈不良事件 (MACE) の有意な差異は認められなかった.
- 高齢のPCI患者の場合,手術用ボリュームは長期的な結果よりも短期的な結果に影響を与える可能性があります.
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