使用静脉复缩的风险作为指南,在手术和皮肤冠状动脉再血管化之间对患者进行分拣
Richard Kettelkamp1, John House, Mukesh Garg
1Mid America Heart Institute, 5th Floor, Saint Luke's Hospital and the University of Missouri-Kansas City, 4100 Wornall Road, Kansas City, MO 64111, USA. kettelkampd@umkc.edu
Circulation
|September 15, 2004
概括
患有复缩风险较高的患者越来越多地通过冠状动脉旁路移植 (CABG) 进行穿皮冠状动脉干预 (PCI) 治疗. 这一趋势表明,需要重新评估目前冠状动脉再血管化的患者分拣策略.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 冠状动脉旁路移植 (CABG) 和皮肤冠状动脉再血管化 (PCI) 是重血管化关键策略.
- 静脉炎是PCI的主要限制,这表明高风险患者可能更喜欢CABG.
- 这项研究调查了基于预测的复原风险的转诊模式.
研究的目的:
- 分析PCI和CABG之间的转诊模式,与预测的复原风险相关.
- 为了确定具有较高复原风险的患者是否优先转诊CABG或PCI.
主要方法:
- 对2320名重血管患者的程序注册的分析.
- 根据八个手术前的特征,患者被分为三组风险组 (11%44%) 恢复性.
- 在这些风险类别中检查了PCI与CABG的转诊模式.
主要成果:
- 在2060次非突发性再血管化手术中,1404次是PCI,656次是CABG.
- 患有低或中等风险的患者接受PCI的可能性是两倍.
- 患有复原风险最高的患者接受PCI的可能性是PCI的三倍 (P=0.015),这表明PCI的偏好趋势.
结论:
- 目前的临床实践表明,与预期相反,偏好将高风险的患者转诊PCI.
- 这些发现需要重新评估PCI和CABG之间的患者分组.
- 这些结果可以为PCI患者的药物释放支架的最佳使用提供信息.
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