Batchelor W B, Peterson E D, Mark D B, Knight J D, Granger C B, Armstrong P W, Califf R M
Duke University Clinical Research Institute, Durham, North Carolina, USA.
J Am Coll Cardiol. 1999 Jul;34(1):12-9. doi: 10.1016/s0735-1097(99)00174-6.
We sought to compare U.S. and Canada's post-myocardial infarction (MI) cardiac catheterization practices in the detection of severe coronary artery disease (CAD).
Little is known about the efficiency with which the aggressive post-MI catheterization strategy observed in the U.S. detects severe CAD compared with the more conservative strategy observed in Canada.
From the U.S. and Canadian patients who had participated in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries trial (n = 22,280, 11.5% Canadian), we examined the frequency of in-hospital cardiac catheterization, the prevalence of severe CAD observed at catheterization (diagnostic efficiency) and the total number of MI patients with severe CAD identified (diagnostic yield).
The rate of catheterization in the U.S. was more than 2.5 times that in Canada (71% vs. 27%, respectively, p < 0.001). With identical prevalences of severe CAD at catheterization (17%) in the two countries, the higher frequency of catheterization in the U.S. resulted in the identification of more than two and a half times as many cases of severe CAD compared with Canada (12 severe CAD cases identified per 100 post-MI patients in the U.S., vs. 4.6 per 100 in Canada). If considered in isolation, we estimated that these differences in severe disease detection might effect a small long-term survival advantage in favor of the U.S. strategy (estimated 5.0 lives saved per 1,000 MI patients).
Canada's more restrictive post-MI cardiac catheterization strategy is no more efficient in identifying severe CAD than the aggressive U.S. strategy, and may fail to identify a substantial number of post-MI patients with high risk coronary anatomy. The long-term impact of these differences in practice patterns requires further evaluation.
我们试图比较美国和加拿大在心肌梗死（MI）后心脏导管插入术检测严重冠状动脉疾病（CAD）方面的做法。
与加拿大更为保守的策略相比，美国在MI后采用的积极导管插入术策略检测严重CAD的效率如何，目前知之甚少。
从参与全球应用链激酶和组织纤溶酶原激活剂治疗闭塞动脉试验的美国和加拿大患者（n = 22280，11.5%为加拿大人）中，我们检查了住院期间心脏导管插入术的频率、导管插入术时观察到的严重CAD的患病率（诊断效率）以及识别出的患有严重CAD的MI患者总数（诊断产量）。
美国的导管插入率是加拿大的2.5倍多（分别为71%和27%，p < 0.001）。两国导管插入术时严重CAD的患病率相同（17%），美国较高的导管插入频率导致识别出的严重CAD病例数是加拿大的两倍半多（美国每100名MI后患者中有12例严重CAD病例，而加拿大每100名中有4.6例）。如果单独考虑，我们估计这些在严重疾病检测方面的差异可能会给美国策略带来微小的长期生存优势（估计每1000名MI患者可挽救5.0条生命）。
加拿大在MI后采用的限制更多的心脏导管插入术策略在识别严重CAD方面并不比积极的美国策略更有效，并且可能无法识别大量具有高危冠状动脉解剖结构的MI后患者。这些实践模式差异的长期影响需要进一步评估。
