关联急性损伤风险和皮肤冠状动脉干预后当天出院的做法
Anezi Uzendu1,2, Rayan El Zein3, Jennifer A Rymer4,5
1Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX USA.
Journal of the American Heart Association
|October 28, 2025
概括
穿皮冠状动脉干预 (PCI) 后的当天泄漏 (SDD) 较少见,急性损伤 (AKI) 风险较高. 然而,许多高风险患者仍然接受SDD,在各医院的实践中存在显著差异.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 穿皮冠状动脉干预 (PCI) 后的当日出血 (SDD) 越来越常见,但可能会受到程序并发症的影响.
- 急性损伤 (AKI) 是PCI后的常见并发症,可能会影响SDD决策.
研究的目的:
- 调查急性损伤 (AKI) 风险与皮肤穿透冠状动脉干预 (PCI) 后当天出院 (SDD) 的做法之间的关联.
- 根据AKI风险和医疗保健网站评估SDD率的趋势和变化.
主要方法:
- 使用国家心血管数据注册表 (NCDR) CathPCI注册表数据从2018年至2022年用于可选PCI.
- 使用NCDR预测模型计算AKI风险,并使用层次逻辑回归来预测SDD.
- 分析了AKI风险类别中SDD率的趋势,并使用中位数赔率 (ORs) 量化了地点变化.
主要成果:
- 分析了超过100万个PCI; 40.1%的患者在同一天出院,其比例从2018年的27.9%增加到2022年的53.4%.
- 较高的AKI风险与较低的SDD率相关 (或每1%增加0.97),但41.2%的高风险患者在2022年患有SDD.
- 在不同地点观察到SDD实践的显著差异,即使是高风险患者 (中位数OR3.60).
结论:
- 虽然较高的AKI风险降低了SDD的可能性,但很大一部分高风险患者 (5%的风险>10%),仍然在同一天出院.
- 对于高风险患者的SDD实践中明显的位置间变异性需要进一步调查.
- 更好地了解AKI患者退院后的风险对于优化PCI输送和安全至关重要.
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