Mack Michael J, Brown Phillip P, Kugelmass Aaron D, Battaglia Salvatore L, Tarkington Lynn G, Simon April W, Culler Steven D, Becker Edmund R
Medical City Dallas Hospital, Dallas, Texas, USA.
Ann Thorac Surg. 2004 Mar;77(3):761-6; discussion 766-8. doi: 10.1016/j.athoracsur.2003.06.019.
Current practice, trends, and early outcomes in patients undergoing surgical and percutaneous coronary interventions (PCI) are changing and subject to speculation.
148,396 consecutive patients in 69 HCA, Inc hospitals who underwent either PCI or coronary artery bypass grafting (CABG) were tracked in the HCA Casemix Database from 1999 through the first quarter of 2002. Comorbid conditions, procedures, complications, and outcome variables were defined through International Classification of Diseases, Ninth Revision coding. Odds ratios (OR) for death and other procedure-related complications were estimated using logistic regression adjusting for age, sex, and 31 other patient clinical and procedural characteristics.
Now 65.4% of all coronary revascularization is by PCI with a 6.8% annual rate of increase whereas CABG volume is declining by 1.9% per year. However the majority of these changes occurred between 1999 and 2000 with only small changes in the last 3 years. Coronary artery bypass grafting is still utilized primarily for multivessel disease (3.38 bypasses per patient) whereas PCI is predominately (83%) still limited to single-vessel intervention. Unadjusted mortality rates over the full 13-quarter period were 1.25% for PCI and 2.63% for CABG (p < 0.001), with PCI rates remaining constant and CABG mortality declining. Twenty-three percent of CABG is performed off pump with a lower mortality than conventional on-pump CABG (2.37% versus 2.69%, p < 0.001). Percutaneous coronary intervention patients have lower mortality (OR 0.51), and fewer acute renal failure (OR 0.39), neurologic (OR 0.12), and cardiac (OR 0.16) complications than CABG patients (p < 0.001).
Interventions for coronary artery disease continue to rise primarily due to an increase in PCI. The volume of PCI continues to increase relative to CABG. Although adverse outcomes are higher after CABG, the proportion of multivessel disease treated is greater. The difference in adverse outcomes between CABG and PCI remains small and continues to decline.
接受外科手术和经皮冠状动脉介入治疗（PCI）患者的当前治疗实践、趋势及早期结果正在发生变化且备受猜测。
1999年至2002年第一季度，在HCA医疗保健公司的69家医院中，对148396例连续接受PCI或冠状动脉旁路移植术（CABG）的患者进行了HCA病例组合数据库跟踪。通过国际疾病分类第九版编码定义合并症、手术、并发症及结果变量。使用逻辑回归对年龄、性别及其他31项患者临床和手术特征进行调整后，估计死亡及其他与手术相关并发症的比值比（OR）。
目前，所有冠状动脉血运重建手术中65.4%为PCI，年增长率为6.8%，而CABG手术量每年下降1.9%。然而，这些变化大多发生在1999年至2000年之间，过去3年仅有微小变化。冠状动脉旁路移植术仍主要用于多支血管病变（每位患者3.38条旁路），而PCI主要（83%）仍局限于单支血管干预。在整个13个季度期间，PCI的未调整死亡率为1.25%，CABG为2.63%（p<0.001），PCI死亡率保持不变，CABG死亡率下降。23%的CABG手术采用非体外循环，死亡率低于传统体外循环CABG（2.37%对2.69%，p<0.001）。与CABG患者相比，经皮冠状动脉介入治疗患者的死亡率较低（OR 0.51），急性肾衰竭（OR 0.39）、神经系统（OR 0.12）和心脏（OR 0.16）并发症较少（p<0.001）。
冠状动脉疾病的干预措施主要因PCI的增加而持续上升。与CABG相比，PCI的手术量持续增加。虽然CABG后的不良结局较高，但治疗的多支血管病变比例更大。CABG和PCI之间的不良结局差异仍然很小且持续下降。
