Roussanov Oleg, Estacio Greta, Capuno Maribeth, Archuleta Linda, Hill Judith, Jarmukli Nabil F
Salem Veterans Administration Medical Center, Salem, VA 24153, USA.
Am Heart J. 2006 Nov;152(5):909-13. doi: 10.1016/j.ahj.2006.05.016.
Percutaneous coronary intervention (PCI) performed in centers without onsite cardiac surgery remains controversial. Advances in PCI techniques and medical therapy have markedly decreased postprocedural complications. Our aim was to assess the efficacy and safety of performing PCI in the Veterans Affairs patient population in a hospital without onsite cardiac surgery.
We prospectively evaluated 401 consecutive patients who underwent elective PCI or PCI after admission for acute coronary syndrome. Patients who had ST-elevation myocardial infarction or were hemodynamically unstable were classified as emergent and had their PCI performed elsewhere and were therefore excluded from our analysis. Our cardiac surgery backup was a community hospital 8 miles away.
The patient's mean age was 65.6 +/- 10 years, and most were men (99.5%). Patients had high-risk clinical and angiographic profiles, with diabetes mellitus in 44%, prior myocardial infarction in 41%, comorbid conditions in 45% and type B or C angiographic lesions in 83%. Of 401 patients, 338 (84%) received a stent, and 86 (21%), a drug eluting stent. Percutaneous coronary intervention success rate was 97%. There were no periprocedural or inhospital deaths, and no patients required emergency transfer for cardiac surgery. At 1 and 6 months of follow-up, total mortality was 1.5% and 3.5%, respectively; target vessel revascularization rate was 0% and 1.7%.
Nonemergent PCI can be performed effectively and safely in patients with higher clinical and angiographic risk without onsite backup cardiac surgery. This has significant implications for most hospitals that have an invasive but not an interventional program.
在没有现场心脏外科手术的中心进行经皮冠状动脉介入治疗(PCI)仍存在争议。PCI技术和药物治疗的进步显著降低了术后并发症。我们的目的是评估在一家没有现场心脏外科手术的退伍军人事务医院对患者进行PCI的有效性和安全性。
我们前瞻性评估了401例连续接受择期PCI或急性冠状动脉综合征入院后PCI的患者。患有ST段抬高型心肌梗死或血流动力学不稳定的患者被分类为急诊患者,他们在其他地方进行了PCI,因此被排除在我们的分析之外。我们的心脏外科后备医院是8英里外的一家社区医院。
患者的平均年龄为65.6±10岁,大多数为男性(99.5%)。患者具有高危临床和血管造影特征,44%患有糖尿病,41%有既往心肌梗死史,45%有合并症,83%有B型或C型血管造影病变。401例患者中,338例(84%)接受了支架植入,86例(21%)接受了药物洗脱支架植入。经皮冠状动脉介入治疗成功率为97%。没有围手术期或住院期间死亡病例,也没有患者需要紧急转院进行心脏手术。在随访1个月和6个月时,总死亡率分别为1.5%和3.5%;靶血管血运重建率分别为0%和1.7%。
在没有现场心脏外科手术后备的情况下,非急诊PCI可以在具有较高临床和血管造影风险的患者中有效且安全地进行。这对大多数有侵入性但没有介入治疗项目的医院具有重要意义。