Rubboli A, Brancaleoni R, Euler D E, Casella G, La Vecchia L, Fontanelli A, Sangiorgio P, Bracchetti D
Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy.
Minerva Cardioangiol. 2001 Dec;49(6):357-62.
Since an inverse relationship between percutaneous coronary angioplasty (PTCA) case-load and in-hospital major adverse cardiac events (MACE) exists, we intended to evaluate the performance of low-volume PTCA operators, during the first year of our interventional program, by applying the more accurate index represented by the MACE rate within the first month.
The data relative to both the PTCA procedure and the control visit 3-4 weeks later, were retrospectively reviewed. Death, myocardial infarction and need for revascularization were the end-points evaluated, both globally and with respect to the individual operators.
During 1999, 61 consecutive patients (53M, 8F; mean age: 59.9+/-10.4 years) were treated by two full-trained operators. Stable angina was the indication in 75% of cases. Comorbidities as diabetes and prior revascularization, were present in 16 and 5% of cases, respectively. Multivessel procedures were performed in 33% of cases, with a total number of lesions of 84 (77% A/B1 type). Stents were implanted in 70% of cases, as a bail-out in 12%. Procedural success rate was 93%. Overall one-month MACE rate was 3.3%, accounted for by 1 in-hospital emergency coronary surgery occurred to operator 1 (3.6% one-month MACE rate) and 1 elective coronary operation performed in a stable patient previously treated by operator 2 (3% one-month MACE rate).
PTCA performed in a low-volume center by low-volume operators is not necessarily associated with a poor outcome, provided that adequate selection of low-risk cases is accomplished. Although only 52% of the Italian centers met in 1999 the recommended volume standards, reaching optimal case-load should anyway be pursued. Some time should however be conceded, provided that close monitoring of one-month MACE rate shows adequate performance of both the institution and the operators.
由于经皮冠状动脉腔内血管成形术（PTCA）的病例数与院内主要不良心脏事件（MACE）之间存在反比关系，我们旨在通过应用第一个月内更准确的MACE率指标，评估我们介入项目第一年中低病例数PTCA术者的表现。
回顾性分析PTCA手术及3 - 4周后对照访视的数据。评估的终点指标为死亡、心肌梗死以及血运重建需求，整体评估以及针对个体术者进行评估。
1999年期间，两名训练有素的术者连续治疗了61例患者（53例男性，8例女性；平均年龄：59.9±10.4岁）。75%的病例指征为稳定型心绞痛。糖尿病和既往血运重建等合并症分别出现在16%和5%的病例中。33%的病例进行了多支血管手术，病变总数为84处（77%为A/B1型）。70%的病例植入了支架，其中12%作为补救措施。手术成功率为93%。总体一个月MACE率为3.3%，由术者1发生的1例院内急诊冠状动脉手术（一个月MACE率为3.6%）和术者2先前治疗的一名稳定患者进行的1例择期冠状动脉手术（一个月MACE率为3%）构成。
低病例数中心由低病例数术者进行的PTCA不一定与不良预后相关，前提是要充分选择低风险病例。尽管1999年只有52%的意大利中心达到了推荐的病例数标准，但无论如何都应追求达到最佳病例数。不过，如果对一个月MACE率的密切监测表明机构和术者的表现良好，应给予一定时间。
