美国冠状动脉复血管化趋势,2001-2008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
概括
冠状动脉复血管化率显著下降,冠状动脉旁路移植 (CABG) 手术利用率下降,而皮肤冠状动脉干预 (PCI) 在2001年至2008年期间在美国医院保持稳定.
科学领域:
- 心血管医学 心血管医学
- 医疗保健服务研究 医疗服务研究
- 干预心脏病学 干预心脏病学
背景情况:
- 冠状动脉再血管化是美国常见的医院手术.
- 新技术,试验证据和指导方针对重血管化趋势的影响尚不清楚.
研究的目的:
- 分析冠状动脉复血管化率和类型的国家趋势.
- 检查冠状动脉旁路移植 (CABG) 手术和穿皮冠状动脉干预 (PCI) 使用情况的变化.
主要方法:
- 2001-2008年美国住院病人的连续横截面研究.
- 使用的医疗保健成本和利用项目的全国性住院患者样本和医疗保险索赔.
- 分析了CABG手术和PCI的年度手术率.
主要成果:
- 从2001-2002年到2007-2008年,冠状动脉复血管化的总体率下降了15%.
- 冠状动脉旁路移植 (CABG) 手术率显著下降,而皮肤冠状动脉干预 (PCI) 率保持稳定.
- 进行CABG手术的医院数量增加,但每家医院的中位数病例数量下降,更多的医院进行的手术较少.
结论:
- 冠状动脉旁路移植 (CABG) 手术的利用率在2001年至2008年期间在美国医院大幅下降.
- 在同一时期,穿皮冠状动脉干预 (PCI) 使用率保持不变.
- 趋势表明重血管化策略的转变,尽管PCI医院可用性增加,但CABG手术的使用量正在下降.
相关概念视频
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:26Coronary Artery Disease IV: Preventive Measures
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:17Ischemic Heart Disease: Overview
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
01:30Coronary Artery Disease I: Introduction
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...