Moscucci Mauro, Eagle Kim A, Share David, Smith Dean, De Franco Anthony C, O'Donnell Michael, Kline-Rogers Eva, Jani Sandeep M, Brown David L
University of Michigan Health System, Ann Arbor, Michigan, USA.
J Am Coll Cardiol. 2005 Jun 7;45(11):1759-65. doi: 10.1016/j.jacc.2005.01.055.
The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI).
Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown.
We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality.
Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88).
There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.
本研究旨在确定公开报告对经皮冠状动脉介入治疗（PCI）病例选择的潜在影响。
先前的研究表明，冠状动脉搭桥手术（CABG）死亡率的公开报告可能导致病例选择偏倚，并导致高危患者得不到治疗或外迁。公开报告对PCI病例选择的潜在影响尚不清楚。
我们将密歇根州一个多中心（八家医院）PCI数据库中纳入的11374例患者（该州无公开报告）的人口统计学、适应症和结局，与纽约州一个全州范围（34家医院）PCI数据库中69048例患者（该州有公开报告）进行了比较。主要终点是住院死亡率。
与纽约州的患者相比，密歇根州的患者因急性心肌梗死接受PCI的频率更高（14.4%对8.7%，p<0.0001），因心源性休克接受PCI的频率更高（2.56%对0.38%，p<0.0001）。密歇根州队列中充血性心力衰竭和心脏外血管疾病的患病率也更高。纽约州未调整的住院死亡率显著低于密歇根州（0.83%对1.54%，p<0.0001；优势比[OR]0.54，95%置信区间[CI]0.45至0.63）。然而，在对合并症进行调整后，两组之间的死亡率没有显著差异（调整后的OR为1.05，95%CI为0.84至1.31，p=0.70，c统计量为0.88）。
密歇根州和纽约州接受PCI治疗的患者在病例组合方面存在显著差异，这导致未调整的死亡率存在明显差异。纽约州因担心高死亡率的公开报告而倾向于不对高危患者进行干预，这可能是这些差异的一个解释。
