保守的方法与皮肤冠状动脉干预在患有自发冠状动脉解剖的患者从全国基于人口的队列研究
Chayakrit Krittanawong1, Beatriz Castillo Rodriguez2, Song Peng Ang3
1Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA.
Reviews in cardiovascular medicine
|December 2, 2024
概括
穿皮冠状动脉干预 (PCI) 用于自发冠状动脉剖析 (SCAD) 与较优医疗疗 (OMT) 相比,与更高的住院死亡率和不良结果有关. 在没有严重表现的SCAD患者中,保守的治疗可能是更好.
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:
- 自发冠状动脉解剖 (SCAD) 是急性冠状动脉综合征 (ACS) 的罕见原因,主要影响没有传统心血管风险因素的年轻女性.
- 由于证据有限,SCAD的最佳管理策略仍在争论中.
- 本研究将SCAD患者接受最佳医疗治疗 (OMT) 和接受皮肤冠状动脉干预 (PCI) 患者之间的临床结果进行比较.
研究的目的:
- 为了比较SCAD患者治疗OMT与PCI的住院临床结果.
- 确定SCAD患者死亡率和其他不良事件的预测因素.
- 为SCAD管理提供基于证据的指导方针.
主要方法:
- 对SCAD患者国家住院样本 (NIS) 数据库 (2016-2020) 的回顾性分析 (ICD-10-CM代码I25.42).
- 排除没有接受PCI或冠状动脉血管学,接受冠状动脉旁路移植或有不完整记录的患者.
- 主要结局:住院死亡率. 二次结果:急性损伤,心脏骤停,心脏性休克,机械循环支持的使用,住院费用和住院时间. 使用了多变量逻辑回归.
主要成果:
- 总共有31,105名SCAD患者被分析 (10,480名OMT,20,625名PCI).
- PCI与增加的住院死亡率 (OR 1.89),心脏性休克 (OR 2.29),LVAD使用 (OR 3.97) 和IABP使用 (OR 2.24) (所有p < 0.001) 有关.
- PCI患者的费用更高,住院时间更长;SCAD患者接受PCI的比例在2016年至2020年间从72%降至60%.
结论:
- 接受PCI的SCAD患者与OMT治疗的患者相比,在医院内出现不良结果的风险明显更高,包括死亡率.
- 研究结果表明,SCAD的保守治疗 (OMT) 具有潜在的优势,特别是在没有严重或不稳定的表现的患者中.
- 需要进一步的研究,以建立基于证据的指导方针,以实现最佳的SCAD管理.
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