Van Brabandt Hans, Camberlin Cécile, Vrijens France, Parmentier Yves, Ramaekers Dirk, Bonneux Luc
Belgian Health Care Knowledge Centre (KCE), Wetstraat 155, B-1040, Brussels, Belgium.
Eur Heart J. 2006 Nov;27(22):2649-54. doi: 10.1093/eurheartj/ehl161. Epub 2006 Aug 4.
To assess the outcome and costs of patients with acute myocardial infarction (AMI) after initial admission to hospitals with or without catheterization facilities in Belgium.
From a nationwide hospital register, we retrieved the data of 34 961 patients discharged during 1999-2001 with a principal diagnosis of AMI. They were initially admitted to hospitals without catheterization facilities (A), with diagnostic (B1) or interventional catheterization facilities (B2). Mortality has been recorded till the end of 2003 and re-admissions till the end of 2001. The mortality hazard ratio and 95% CI of 5 years mortality of A vs. B2 was 1.01 (0.97, 1.06) and of B1 vs. B2 was 1.03 (0.98, 1.09). Re-admission rates and 95% CI for cardiovascular reason per 100 patient-years were 23.5 (22.7, 24.3) for A, 23.8 (22.5, 25.1) for B1, and 22.0 (21.2, 22.9) for B2. The mean cost in hospital of a patient at low risk with a single stay was in A 4072 euro (median: 3,861; IQR: 4467-3476), in B1 5083 euro (median: 5153; IQR: 5769-4340), and in B2 7741 euro (median: 7553; IQR: 8211-7298).
Services with catheterization facilities compared with services without them showed no better health outcomes, but delivered more expensive care.
评估比利时急性心肌梗死（AMI）患者在初次入住有或无导管插入设备的医院后的治疗结果及费用。
从全国医院登记处，我们获取了1999 - 2001年期间出院的34961例主要诊断为AMI患者的数据。他们最初入住无导管插入设备的医院（A组）、有诊断性（B1组）或介入性导管插入设备的医院（B2组）。记录了直至2003年底的死亡率以及直至2001年底的再入院情况。A组与B2组5年死亡率的死亡风险比及95%可信区间为1.01（0.97，1.06），B1组与B2组为1.03（0.98，1.09）。每100患者年因心血管原因的再入院率及95%可信区间，A组为23.5（22.7，24.3），B1组为23.8（22.5，25.1），B2组为22.0（21.2，22.9）。单次住院的低风险患者的平均住院费用，A组为4072欧元（中位数：3861；四分位数间距：4467 - 3476），B1组为5083欧元（中位数：5153；四分位数间距：5769 - 4340），B2组为7741欧元（中位数：7553；四分位数间距：8211 - 7298）。
有导管插入设备的医疗服务与无导管插入设备的医疗服务相比，并未显示出更好的健康结果，但提供的护理费用更高。
