穿皮冠状动脉干预后死亡原因的趋势
Daniel B Spoon1, Peter J Psaltis, Mandeep Singh
1Divisions of Cardiovascular Diseases (D.B.S., P.J.P., M.S., D.R.H., B.J.G., C.S.R., R.D.S., R.G.) and Biomedical Statistics and Informatics (R.J.L.), Mayo Clinic, Rochester, MN; and Division of Cardiovascular Diseases (I.D.M.), Mayo Clinic, Jacksonville, FL.
Circulation
|February 12, 2014
概括
在过去的二十年中,穿皮冠状动脉干预 (PCI) 后的死亡率从心脏原因转移到癌症等非心脏原因. 这一趋势无论患者的特征如何,都会发生,突出显示PCI后死亡率模式的变化.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 公共卫生 公共卫生
背景情况:
- 穿皮冠状动脉干预 (PCI) 后的长期死亡原因尚未完全理解,特别是随着患者人口结构的变化.
- 了解这些趋势对于改善患者治疗结果和医疗保健策略至关重要.
研究的目的:
- 评估PCI后特定原因长期死亡率的时间趋势.
- 确定二十年来死亡原因的变化及其与患者特征的关系.
主要方法:
- 一项单中心研究分析了1991年至2008年接受PCI的19077名患者,随访时间为2012年.
- 特定原因死亡率通过前性监测,采访,医疗记录和死亡证明来确定.
- 竞争风险分析比较了三个PCI时期的死亡率:1991-1996,1997-2002年和2003-2008年.
主要成果:
- 在PCI后5年的心脏病死亡人数下降了33% (9.8%至6.6%),而非心脏病死亡人数在研究期间增加了57% (7.1%至11.2%).
- 在最近的时代,只有36.8%的死亡是与心脏有关的.
- 经过调整后的分析显示,心脏病死亡率下降了50%,但非心脏病死亡率没有变化,由癌症和慢性疾病驱动的增加.
结论:
- 在PCI后的死亡原因中,从心脏到非心脏的死亡原因的显著时间转移在20年内被观察到.
- 心脏病死亡率的降低独立于患者的基线特征.
- 这些发现需要对PCI后护理策略和临床试验设计进行重新评估,以解决非心脏病死亡率的问题.
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