Chen Edmond W, Canto John G, Parsons Lori S, Peterson Eric D, Littrell Katherine A, Every Nathan R, Gibson C Michael, Hochman Judith S, Ohman E Magnus, Cheeks Morris, Barron Hal V
Division of Cardiology, Kaiser Permanente Medical Group, Inc, Richmond, CA 94801-3195, USA.
Circulation. 2003 Aug 26;108(8):951-7. doi: 10.1161/01.CIR.0000085068.59734.E4. Epub 2003 Aug 11.
Increasing evidence suggests an inverse relationship between outcome and the total number of invasive cardiac procedures performed at a given hospital. The purpose of the present study was to determine if a similar relationship exists between the number of intra-aortic balloon counterpulsation (IABP) procedures performed at a given hospital per year and the in-hospital mortality rate of patients with acute myocardial infarction complicated by cardiogenic shock.
We analyzed data of 12 730 patients at 750 hospitals enrolled in the National Registry of Myocardial Infarction 2 from 1994 to 1998. The hospitals were divided into tertiles (low-, intermediate-, and high-IABP volume hospitals) according to the number of IABPs performed at the given hospital per year. The median number of IABPs performed per hospital per year was 3.4, 12.7, and 37.4 IABPs at low-, intermediate-, and high-volume hospitals, respectively. Of those patients who underwent IABP, there were only minor differences in baseline patient characteristics between the 3 groups. Crude mortality rate decreased with increasing IABP volume: 65.4%, lowest volume tertile; 54.1%, intermediate volume tertile; and 50.6%, highest volume tertile (P for trend <0.001). This mortality difference represented 150 fewer deaths per 1000 patients treated at the high IABP hospitals. In the multivariate analysis, high hospital IABP volume for patients with acute myocardial infarction was associated with lower mortality (OR=0.71, 95% CI=0.56 to 0.90), independent of baseline patient characteristics, hospital factors, treatment, and procedures such as PTCA.
Among the myocardial infarction patients with cardiogenic shock who underwent IABP placement, mortality rate was significantly lower at high-IABP volume hospitals compared with low-IABP volume hospitals.
越来越多的证据表明，在特定医院进行的侵入性心脏手术总数与手术结果之间存在反比关系。本研究的目的是确定在特定医院每年进行的主动脉内球囊反搏（IABP）手术数量与急性心肌梗死并发心源性休克患者的院内死亡率之间是否存在类似关系。
我们分析了1994年至1998年纳入国家心肌梗死注册2的750家医院中12730例患者的数据。根据特定医院每年进行的IABP数量，将医院分为三分位数（低、中、高IABP量医院）。低、中、高容量医院每年每家医院进行的IABP中位数分别为3.4、12.7和37.4次。在接受IABP治疗的患者中，三组患者的基线特征仅有微小差异。粗死亡率随着IABP量的增加而降低：最低量三分位数为65.4%；中间量三分位数为54.1%；最高量三分位数为50.6%（趋势P<0.001）。这种死亡率差异意味着在高IABP医院每治疗1000例患者死亡人数减少150人。在多变量分析中，急性心肌梗死患者的高医院IABP量与较低死亡率相关（OR=0.71，95%CI=0.56至0.90），与患者基线特征、医院因素、治疗以及诸如PTCA等手术无关。
在接受IABP植入的心肌梗死并发心源性休克患者中，高IABP量医院的死亡率显著低于低IABP量医院。
