Frutkin Andrew D, Mehta Sameer K, Patel Taral, Menon Pramod, Safley David M, House John, Barth Charles W, Grantham J Aaron, Marso Steven P
Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri, USA.
Am J Cardiol. 2008 Jan 1;101(1):53-7. doi: 10.1016/j.amjcard.2007.07.047.
We evaluated the efficacy and safety of elective percutaneous coronary intervention (PCI) at a hospital without onsite cardiac surgery. A growing number of hospitals without onsite cardiac surgery perform elective PCI. Few hospitals have reported outcomes, despite controversy surrounding this practice. From August 2003 to December 2005, 1,090 elective PCI were performed at Saint Luke's South Hospital (SLS), a hospital without onsite cardiac surgery, for which the referral center is the Mid America Heart Institute (MAHI). The elective PCI program used experienced interventionalists, technicians, and nurses; a tested helicopter transport protocol; a well-equipped catheterization laboratory; and a quality assurance process. Baseline characteristics, procedural success, and adverse clinical outcomes were compared. Observed frequencies of in-hospital death, a combined end point of Q-wave myocardial infarction (MI)/emergency coronary artery bypass grafting (CABG) surgery, and vascular complications were compared with prediction models. SLS, with lower risk characteristics than MAHI, had unadjusted frequencies of procedural success (93% vs 94%, p = NS), Q-wave MI (0.3% vs 0.3%, p = NS), emergency CABG surgery (0.2% vs 0.03%, p = 0.09), vascular complications (0.6% vs 0.6%, p = NS), and in-hospital death (0.1% vs 0.8%, p = 0.002) that compared favorably with MAHI. Two patients transferred from SLS to MAHI for emergency CABG surgery without adverse effects. Fewer in-hospital deaths and vascular complications were observed at SLS than predicted by models. In conclusion, favorable clinical outcomes were achieved for elective PCI at a hospital without onsite cardiac surgery that used strict program requirements.
我们评估了在一家没有现场心脏手术设施的医院进行择期经皮冠状动脉介入治疗（PCI）的疗效和安全性。越来越多没有现场心脏手术设施的医院开展择期PCI。尽管这种做法存在争议，但很少有医院报告相关结果。2003年8月至2005年12月，在圣卢克南方医院（SLS）进行了1090例择期PCI，该医院没有现场心脏手术设施，其转诊中心是美国中部心脏研究所（MAHI）。该择期PCI项目配备了经验丰富的介入医生、技术人员和护士；采用了经过测试的直升机转运方案；拥有设备完善的导管实验室；并设有质量保证流程。对基线特征、手术成功率和不良临床结局进行了比较。将观察到的院内死亡、Q波心肌梗死（MI）/急诊冠状动脉旁路移植术（CABG）手术这一联合终点以及血管并发症的发生频率与预测模型进行了比较。SLS的风险特征低于MAHI，其未调整的手术成功率（93%对94%，p =无显著性差异）、Q波MI（0.3%对0.3%，p =无显著性差异）、急诊CABG手术（0.2%对0.03%，p = 0.09）、血管并发症（0.6%对0.6%，p =无显著性差异）和院内死亡（0.1%对0.8%，p = 0.002）频率与MAHI相比具有优势。两名患者从SLS转至MAHI进行急诊CABG手术，未出现不良反应。SLS观察到的院内死亡和血管并发症少于模型预测值。总之，在一家没有现场心脏手术设施但采用严格项目要求的医院，择期PCI取得了良好的临床效果。
