在医疗保险受益者中,慢性全包裹性皮肤冠状动脉干预的长期结果
Zaid I Almarzooq1,2, Hector Tamez1, Yongfei Wang3,4
1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
概括
慢性全封闭 (CTO) 穿皮冠状动脉干预 (PCI) 与高风险的非CTO PCI相比,在医院的风险较高,但长期风险较低. 这些发现有助于临床医生和患者理解PCI结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 健康 结果 研究 研究 结果
背景情况:
- 慢性全封闭 (CTO) 穿皮冠状动脉干预 (PCI) 占美国PCI稳定性 angina 的4%.
- 与非CTO PCI相比,CTO PCI与较低的成功率和更高的住院事件率有关.
- 需要检查CTO PCI与非CTO PCI的长期结果,包括高风险子组.
研究的目的:
- 将CTO PCI的长期结果与非CTO PCI进行比较.
- 评估CTO PCI结果与高风险非CTO PCI子组 (动脉切除术,SVG,无保护的左主).
主要方法:
- 来自国家心血管数据注册表CathPCI注册表与Medicare相关的551,722名患者的分析 (2009年7月至2016年12月).
- 在CTO PCI (N=29,407) 和非CTO PCI (N=522,315) 之间的住院和长期主要不良心血管事件 (MACE) 的比较.
- 对CTO PCI与高风险非CTO PCI (N=53,662) 的比较分析,不包括STEMI和NSTEMI患者.
主要成果:
- CTO PCI患者年轻,更有可能是男性.
- 与非CTO PCI (7.0%对4.2%) 和高风险非CTO PCI (7.0%对6.5%) 相比,CTO PCI的住院事件率更高.
- 与高风险非CTO PCI相比,CTO PCI显示了长期重复血管化的风险略高 (aHR,1.09),但长期MACE (aHR,0.87) 和再录取 (aHR,0.87) 的风险较低.
结论:
- CTO PCI与增加的医院内外事件风险有关.
- 与高风险非CTO PCI相比,CTO PCI显示长期事件的风险略低.
- 这些发现突显了PCI程序的复杂性,为临床决策和患者的期望提供了信息.
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