通过皮肤冠状动脉干预在有或没有现场手术备份的中心:对23项研究的更新元分析
Joo Myung Lee1, Doyeon Hwang1, Jonghanne Park1
1From Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K., B.-K.K.); Division of Biostatistics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD (C.A.); and Institute of Aging, Seoul National University, Korea (B.-K.K.).
Circulation
|July 9, 2015
概括
穿皮冠状动脉干预 (PCI) 的结果在有或没有现场手术的中心是相似的. 这适用于心脏病发作的主要PCI和非主要PCI,死亡率或并发症没有显著差异.
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:
- 经皮冠状动脉干预 (PCI) 后的紧急冠状动脉旁路移植 (CABG) 现在不常见.
- 在有或没有现场手术备用中心的PCI的安全性和有效性需要进行当前评估.
研究的目的:
- 为了比较在有或没有现场手术能力的中心进行的初级和非初级PCI的临床结果和并发症率.
- 评估现场手术备份对PCI程序期间患者安全的影响.
主要方法:
- 一个更新的系统综述和对23项高质量的研究的元分析,涉及超过110万接受PCI的患者.
- 混合效应模型被用来比较有和没有现场手术的中心之间的结果.
- 分析包括ST段升高心肌梗塞的初级PCI和非初级PCI,检查死亡率和紧急CABG率.
主要成果:
- 对于初级PCI (133,574名患者),在所有原因的死亡率 (OR 0.99) 或紧急CABG (OR 0.76) 之间没有观察到有或没有现场手术的中心之间的显著差异.
- 对于非初级PCI (967,549名患者),所有原因死亡率 (OR 1.15) 和紧急CABG (OR 1.14) 率也没有显著差异.
- 在两种类型的中心中,PCI并发症率,包括心脏性休克,中风和复发性心脏病发作,是可比的.
- 累积元分析显示,2007年后非初级PCI中所有原因死亡率的效应大小在时间上有所下降.
结论:
- PCI显示了类似的临床结果和并发症率,无论是否有初级和非初级手术的现场手术备用.
- 时间趋势表明,即使在没有现场外科支持的中心,非初级PCI的临床结果也在不断改善.
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