Gottwik M, Zeymer U, Schneider S, Senges J
Klinikum Nürnberg Süd, Medizinische Klinik 8, Nürnberg, Germany.
Dtsch Med Wochenschr. 2003 Oct 10;128(41):2121-4. doi: 10.1055/s-2003-42863.
Absolute numbers of cardiovascular procedures are higher in Germany as compared to other European countries. This fact is used as an argument for overuse. Therefore other indicators of an inappropriate use of these resources should be of interest.
The relationship between diagnostic cardiac catheterisations and consequent revascularisation procedures were compared in 8 European countries. In addition the indication criteria for cardiac catheterisations were reviewed in a German registry of 205.581 consecutive inpatients.
Revascularisation procedures after diagnostic catheterisations in 8 countries range from 39,1 % to 57,9 %. Germany reaches 43,2 %. A relation between absolute numbers of diagnostic and percent subsequent revascularisation procedures does not exist. In a German registry the following indications for cardiac catheterisation could be identified: Acute Coronary Syndrome 22,9 %. Angina pectoris according to the Canadian Cardiac Society classification was present: CCS II/III in 80,3 %, CCS IV in 17,2 %. An exercise test was performed in 43 %. Final diagnoses were: significant coronary disease 69,5 %, exclusion of disease 9,4 %, lesions < 50 % 9 %, other cardiac disease 12,1 %.
Absolute numbers cannot be used as an indicator of overuse of cardiovascular procedures. Instead standards for data acquisition should be established on European, national and regional levels. In addition a validation procedure for criteria has to be developed in order to judge the appropriateness of indications for invasive cardiac procedures in different health care systems.
与其他欧洲国家相比，德国心血管手术的绝对数量更高。这一事实被用作过度使用的论据。因此，这些资源不当使用的其他指标应受到关注。
比较了8个欧洲国家诊断性心导管插入术与后续血运重建手术之间的关系。此外，在德国一个包含205581例连续住院患者的登记处中，对心导管插入术的指征标准进行了审查。
8个国家诊断性导管插入术后的血运重建手术比例在39.1%至57.9%之间。德国为43.2%。诊断性手术的绝对数量与后续血运重建手术的百分比之间不存在关联。在德国的登记处中，可确定以下心导管插入术的指征：急性冠状动脉综合征占22.9%。根据加拿大心血管学会分类，存在心绞痛：CCS II/III级占80.3%，CCS IV级占17.2%。43%的患者进行了运动试验。最终诊断结果为：显著冠状动脉疾病占69.5%，排除疾病占9.4%，病变<50%占9%，其他心脏疾病占12.1%。
绝对数量不能用作心血管手术过度使用的指标。相反，应在欧洲、国家和地区层面建立数据采集标准。此外，必须制定标准的验证程序，以判断不同医疗保健系统中侵入性心脏手术指征的合理性。
