在超大缺陷性阻塞性心肌病患者的 Septal Reduction 疗法后的程序体积和结果
Nirav Patel1, Naman S Shetty2,3, Mokshad Gaonkar1
1Division of Cardiovascular Disease University of Alabama at Birmingham Birmingham AL.
Journal of the American Heart Association
|October 25, 2024
概括
低体积隔膜缩小疗法治疗高伤心肌病与更糟糕的患者结局有关. 高体积的中心和经验丰富的操作人员对于隔膜肌切除术和酒精隔膜切除术的更好的结果至关重要.
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:
- 隔膜缩小疗法,包括隔膜肌切除和酒精隔膜切除 (ASA),用于治疗症状阻塞性多变性心肌病.
- 操作员和医院的程序量可能会影响患者的结果,但目前的数据有限.
研究的目的:
- 调查操作员和医院体积之间的关联以及隔膜缩小疗法的结果.
- 根据程序量分析30天死亡率和90天再接收率.
主要方法:
- 使用Vizient临床数据库 (2016-2022) 进行回顾性队列研究.
- 使用ICD-10-CM代码进行隔膜肌切除或ASA的确定的患者.
- 根据经营者和医院的年体积分患者分为低,中,高体积组.
- 分析了30天住院死亡率和90天再入院率,使用多变量物流和Cox模型.
主要成果:
- 隔膜肌切除术的低体积操作人员显示,30天死亡率和90天再接收风险更高.
- 中量运营商和隔膜肌切除术的医院增加了30天的死亡率.
- 隔膜肌切除术的低体积医院有更大的90天再入院的风险.
- 对ASA的低和中量运营商增加了30天死亡率;医院的数量没有显著影响ASA的结果.
结论:
- 较低的操作员和医院体积与隔膜缩小疗法的不良结果有关.
- 建议将多变性心肌病患者转移到经验丰富的经验丰富的操作员的高体积中心,以改善结果.
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