Ting Henry H, Raveendran Ganesh, Lennon Ryan J, Long Kirsten Hall, Singh Mandeep, Wood Douglas L, Gersh Bernard J, Rihal Charanjit S, Holmes David R
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2006 Apr 18;47(8):1713-21. doi: 10.1016/j.jacc.2006.02.039. Epub 2006 Mar 13.
We sought to compare clinical outcomes of elective percutaneous coronary intervention (PCI) and primary PCI for ST-segment elevation myocardial infarction (STEMI) at a community hospital without onsite cardiac surgery to those at a tertiary center with onsite cardiac surgery.
Disagreement exists about whether hospitals with cardiac catheterization laboratories, but without onsite cardiac surgery, should develop PCI programs. Primary PCI for STEMI at hospitals without onsite cardiac surgery have achieved satisfactory outcomes; however, elective PCI outcomes are not well defined.
A total of 1,007 elective PCI and primary PCI procedures performed from March 1999 to August 2005 at the Immanuel St. Joseph's Hospital-Mayo Health System (ISJ) in Mankato, Minnesota, were matched one-to-one with those performed at St. Mary's Hospital (SMH) in Rochester, Minnesota. Strict protocols were followed for case selection and PCI program requirements. Clinical outcomes (in-hospital procedural success, death, any myocardial infarction, Q-wave myocardial infarction, and emergency coronary artery bypass surgery) and follow-up survival were compared between groups.
Among 722 elective PCIs, procedural success was 97% at ISJ compared with 95% at SMH (p = 0.046). Among 285 primary PCIs for STEMI, procedural success was 93% at ISJ and 96% at SMH (p = 0.085). No patients at ISJ undergoing PCI required emergent transfer for cardiac surgery. Survival at two years' follow-up by treatment location was similar for patients with elective PCI and primary PCI.
Similar clinical outcomes for elective PCI and primary PCI were achieved at a community hospital without onsite cardiac surgery compared with those at a tertiary center with onsite cardiac surgery using a prospective, rigorous protocol for case selection and PCI program requirements.
我们试图比较在一家没有现场心脏外科手术的社区医院进行择期经皮冠状动脉介入治疗（PCI）和ST段抬高型心肌梗死（STEMI）直接PCI的临床结果与一家有现场心脏外科手术的三级中心的临床结果。
对于拥有心导管实验室但没有现场心脏外科手术的医院是否应开展PCI项目存在分歧。在没有现场心脏外科手术的医院进行STEMI直接PCI已取得了令人满意的结果；然而，择期PCI的结果尚无明确界定。
1999年3月至2005年8月在明尼苏达州曼卡托市伊曼纽尔圣约瑟夫医院-梅奥医疗系统（ISJ）进行的1007例择期PCI和直接PCI手术与在明尼苏达州罗切斯特市圣玛丽医院（SMH）进行的手术进行一对一匹配。病例选择和PCI项目要求遵循严格的方案。比较两组之间的临床结果（院内手术成功率、死亡、任何心肌梗死、Q波心肌梗死和急诊冠状动脉搭桥手术）以及随访生存率。
在722例择期PCI中，ISJ的手术成功率为97%，而SMH为95%（p = 0.046）。在285例STEMI直接PCI中，ISJ的手术成功率为93%，SMH为96%（p = 0.085）。在ISJ接受PCI的患者中，没有患者需要紧急转往心脏外科手术。择期PCI和直接PCI患者按治疗地点进行的两年随访生存率相似。
与一家有现场心脏外科手术的三级中心相比，一家没有现场心脏外科手术的社区医院采用前瞻性、严格的病例选择方案和PCI项目要求，在择期PCI和直接PCI方面取得了相似的临床结果。
