Jamal Shelina M, Shrive Fiona M, Ghali William A, Knudtson Merrill L, Eisenberg Mark J
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Can J Cardiol. 2003 Jun;19(7):782-9.
Despite existing research on outcomes of cardiac care in Canada, little is known about Canada-wide trends and interprovincial differences in outcomes after percutaneous coronary intervention (PCI).
To examine Canadian trends in rates of in-hospital mortality and same-admission coronary artery bypass grafting (CABG) after PCI and to compare provincial risk-adjusted in-hospital death and same-admission CABG rates.
Hospital discharge abstract data were obtained from the Canadian Institute for Health Information and were used to identify cohorts of patients who underwent PCI in eight provinces in fiscal years 1992/93 through 2000/01. Crude data from Quebec hospitals were available for calendar years 1998 and 1999. Logistic regression modelling was used to calculate risk-adjusted in-hospital death and same-admission CABG rates by year and province.
A total of 127,103 PCI cases performed in 23 hospitals across eight provinces were examined, with an overall unadjusted death rate of 1.4% and an overall unadjusted CABG rate of 1.6%. A national trend of stable in-hospital mortality rates was observed with a risk-adjusted death rate of 1.4% in 1992/93 versus 1.4% in 2000/01. An overall decline was seen in rates of same-admission CABG with a risk-adjusted rate of 2.7% in 1992/93 versus 0.9% in 2000/01 (relative decrease 67%, P<0.01). New Brunswick, Manitoba and British Columbia achieved overall declines in risk-adjusted death rates over the study period, while the other provinces experienced a slight increase (Newfoundland, Nova Scotia, Ontario, Alberta and Saskatchewan). All provinces displayed a similar decline in risk-adjusted same-admission CABG rates post-PCI.
Risk-adjusted rates of in-hospital death after PCI in Canada have remained stable over nine years, while risk-adjusted rates of same-admission CABG have decreased. The presence of interprovincial differences in risk-adjusted outcomes raises the possibility of variable quality of care for patients undergoing PCI across the Canadian provinces.
尽管已有关于加拿大心脏护理结果的研究，但对于经皮冠状动脉介入治疗（PCI）后全国范围内的趋势以及省际间结果差异仍知之甚少。
研究加拿大PCI后住院死亡率和同期冠状动脉旁路移植术（CABG）发生率的趋势，并比较各省经风险调整后的住院死亡率和同期CABG发生率。
从加拿大卫生信息研究所获取医院出院摘要数据，用于确定1992/93财年至2000/01财年在八个省份接受PCI的患者队列。魁北克省医院的原始数据可获取1998年和1999年的。采用逻辑回归模型计算按年份和省份调整后的住院死亡率和同期CABG发生率。
共检查了八个省份23家医院进行的127,103例PCI病例，总体未调整死亡率为1.4%，总体未调整CABG率为1.6%。观察到全国住院死亡率呈稳定趋势，1992/93年风险调整死亡率为1.4%，2000/01年为1.4%。同期CABG发生率总体呈下降趋势，1992/93年风险调整率为2.7%，2000/01年为0.9%（相对下降67%，P<0.01）。新不伦瑞克省、曼尼托巴省和不列颠哥伦比亚省在研究期间风险调整死亡率总体下降，而其他省份略有上升（纽芬兰省、新斯科舍省、安大略省、艾伯塔省和萨斯喀彻温省）。所有省份PCI后风险调整后的同期CABG发生率均呈类似下降趋势。
加拿大PCI后经风险调整的住院死亡率在九年内保持稳定，而同期CABG的风险调整率有所下降。经风险调整的结果存在省际差异，这增加了加拿大各省接受PCI患者护理质量参差不齐的可能性。
