经皮冠状动脉干预后操作体积与长期结果之间的关系
Alexander C Fanaroff1,2, Pearl Zakroysky2, Daniel Wojdyla2
1Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.
Circulation
|December 28, 2018
概括
穿皮冠状动脉干预 (PCI) 的操作人员体积较大与老年人住院死亡率较低有关. 然而,在风险调整后,长期结果如主要冠状动脉不良事件 (MACE) 没有显著差异.
科学领域:
- 心血管医学
- 医疗服务研究
背景情况:
- 经皮冠状动脉干预 (PCI) 后,已知操作者手术量会影响短期结果.
- 经营者PCI量与长期患者结果之间的关联在很大程度上是未知的.
- 了解这种关系对于优化患者护理和程序质量至关重要.
研究的目的:
- 在65岁及以上的患者中研究经营者穿皮冠状动脉干预 (PCI) 量与长期结果之间的关联.
- 根据每年PCI量进行分层,并分析它们对患者死亡率和主要冠状动脉不良事件的影响.
- 确定PCI后操作人员体积的增加是否与患者长期健康状况的改善或下降有关.
主要方法:
- 使用国家心血管数据注册表CathPCI注册表与医疗保险索赔数据连接.
- 将8,936个经营者分为低 (<50),中等 (50-100) 和高 (>100) 年度PCI量类别.
- 使用卡普兰- 梅尔和比例危险模型计算了未调整和风险调整的1年死亡率和MACE (死亡,心肌梗塞再入院或计划外再血管化).
主要成果:
- 在2009年7月至2014年12月期间,共分析了723,644个PCI程序.
- 较少人数的操作人员进行了更多的紧急PCI,并治疗了较少伴随性疾病的患者.
- 经过风险调整后,中等和高容量的操作人员与低容量的操作人员相比,在住院死亡率显著降低,但在出院后的一年后的MACE中没有显著差异.
结论:
- 对于老年人来说,PCI中使用者数量较高与住院死亡率的降低有关.
- 在从医院出院到1年的随访期间,不同操作者体积组之间没有发现重大冠状动脉不良事件 (MACE) 的显著差异.
- 对于老年PCI患者来说,操作程序的体积可能比长期结果更多地影响短期结果.
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