Doucet Michel, Eisenberg Mark, Joseph Lawrence, Pilote Louise
Division of Clinical Epidemiology, The Montreal General Hospital Research Institute, The McGill University Health Center, Montreal, Quebec, Canada.
Am Heart J. 2002 Jul;144(1):144-50. doi: 10.1067/mhj.2002.123571.
Volume of procedures has been associated with short-term outcome after percutaneous transluminal coronary angioplasty. However, the effect of hospital procedural volume on long-term outcome after PTCA is unknown.
We analyzed the physician claims and discharge data of 6635 patients who underwent PTCA after acute myocardial infarction (AMI) between 1991 and 1995 in the province of Quebec, Canada. For each administrative year, hospitals in which PTCA was performed were classified into 3 groups: low-volume, <200 procedures per year; medium-volume, 200 to 399 procedures per year; and high-volume, > or =400 procedures per year. Compared with patients in medium-volume and high-volume hospitals, patients in low-volume hospitals were older, had more recent AMI, and were less likely to have been transferred for PTCA. After adjustment for baseline differences, patients in the low-volume and medium-volume groups were more likely to undergo CABG within 6 months compared with patients in the high-volume group (odds ratio [OR] 2.1, 95% CI 1.3-3.3, and OR 1.5, 95% CI 1.2-1.9, respectively). In contrast, patients in the low-volume and medium-volume groups were less likely than patients in the high-volume group to undergo repeat PTCA within 6 months (OR 0.37, 95% CI 0.24-0.58, and OR 0.8, 95% CI 0.70-0.92, respectively). At 6 months, adjusted rates of repeat revascularization, recurrent AMI, or death did not differ between the 3 groups.
Overall adverse event rates at 6 months after PTCA do not differ between hospital volume groups. The higher rate of CABG in low-volume hospitals and the higher rate of repeat PTCA in high-volume hospitals may represent different physician preferences for the treatment of failed PTCA rather than higher complication rates.
经皮腔内冠状动脉成形术（PTCA）后手术量与短期预后相关。然而，医院手术量对PTCA后长期预后的影响尚不清楚。
我们分析了1991年至1995年期间在加拿大魁北克省因急性心肌梗死（AMI）接受PTCA的6635例患者的医生索赔和出院数据。对于每个行政年度，进行PTCA的医院分为3组：低手术量组，每年<200例手术；中等手术量组，每年200至399例手术；高手术量组，每年≥400例手术。与中等手术量和高手术量医院的患者相比，低手术量医院的患者年龄更大，AMI发生时间更近，且因PTCA而被转诊的可能性更小。在对基线差异进行调整后，低手术量组和中等手术量组的患者在6个月内接受冠状动脉旁路移植术（CABG）的可能性高于高手术量组（优势比[OR]分别为2.1，95%可信区间[CI]为1.3 - 3.3，以及OR 1.5，95%CI为1.2 - 1.9）。相反，低手术量组和中等手术量组的患者在6个月内接受重复PTCA的可能性低于高手术量组（OR分别为0.37，95%CI为0.24 - 0.58，以及OR 0.8，95%CI为0.70 - 0.92）。在6个月时，3组之间重复血运重建、复发性AMI或死亡的调整发生率没有差异。
PTCA后6个月时，不同医院手术量组的总体不良事件发生率没有差异。低手术量医院较高的CABG率和高手术量医院较高的重复PTCA率可能代表了医生对PTCA失败治疗的不同偏好，而非更高的并发症发生率。
