冠状动脉再血管化的适当使用标准和使用趋势,患者选择以及穿皮冠状动脉干预的适当性
Nihar R Desai1, Steven M Bradley2, Craig S Parzynski3
1Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
JAMA
|November 10, 2015
概括
冠状动脉再循环的适当使用标准导致非紧急皮肤冠状动脉干预 (PCI) 程序的减少. 虽然不适当的PCI使用减少了,但医院之间的差异仍然存在,这凸显了最佳患者选择的持续挑战.
科学领域:
- 心血管医学
- 医疗服务研究
- 干预心脏病学
背景情况:
- 为指导患者选择穿皮冠状动脉干预 (PCI) 制定了冠状动脉再血管化的适当使用标准.
- 根据这些标准,PCI适用性的国家趋势没有得到充分证实.
研究的目的:
- 在实施适当使用标准后分析PCI利用和患者选择的趋势.
- 通过时间来评估PCI的程序性适当性的变化.
主要方法:
- 从2009年到2014年进行了270万个PCI程序的多中心纵向分析.
- 数据来源于国家心血管数据注册表CathPCI注册表.
- 使用2012年适当使用标准来评估被归类为不合适的非急性PCI的比例.
主要成果:
- 非急性PCI的数量显著下降,而急性PCI的数量保持稳定.
- 接受非急性PCI的患者表现出心痛严重程度的增加和手术前的药物使用.
- 不适当的非急性PCI的比例从26. 2%降至13. 3%,绝对数量也相应降低.
结论:
- 适当使用标准与非急性PCI量和不适当使用的显著减少有关.
- 尽管整体情况有所改善,但不适当的PCI率仍然存在实质性的医院水平差异.
- 需要进一步努力,在医疗保健设施中标准化适当的PCI使用.
相关概念视频
Coronary Artery Disease V: Interprofessional Care
400
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...
400
Acute Coronary Syndrome IV: Interprofessional Care
450
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...
450
Cardiac Catheterization I: Pre-Procedure Overview
2.6K
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
2.6K
Peripheral Artery Disease III: Interprofessional Care
559
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
559
Angina IV: Management
419
IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
419
Cardiac Catheterization II: Right Heart Catheterization
1.8K
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
1.8K


