Apolito Renato A, Greenberg Mark A, Menegus Mark A, Lowe April M, Sleeper Lynn A, Goldberger Mark H, Remick Joshua, Radford Martha J, Hochman Judith S
Cardiovascular Clinical Research Center, The Leon H. Charney Department of Cardiology, New York University School of Medicine, New York, NY 10016, USA.
Am Heart J. 2008 Feb;155(2):267-73. doi: 10.1016/j.ahj.2007.10.013. Epub 2007 Dec 19.
Studies suggest that the New York State Cardiac Surgery and Percutaneous Coronary Intervention Reporting System, which makes public the operator-specific mortality for patients undergoing coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI), may deter operators from providing revascularization to high-risk cardiac patients in New York compared to other states.
We performed a retrospective analysis of 545 US patients with acute myocardial infarction and cardiogenic shock due to predominant left ventricular failure enrolled in the SHOCK Registry. Adjusting for case mix using a propensity score method, we compared the use of coronary angiography, PCI, CABG, and outcomes between 220 patients in New York and 325 in other states.
New York patients were older with similar or less severe baseline characteristics. After propensity score adjustment, New York patients were less likely than non-New York patients to undergo coronary angiography (odds ratio 0.46, 95% CI 0.31-0.68, P < .001) and PCI (odds ratio 0.51, 95% CI 0.33-0.77, P = .002). Coronary artery bypass graft rates were similarly low (14.1% vs 15.1%, P = not significant), but New York patients waited significantly longer after shock onset for surgery (101.2 vs 10.3 hours, P < .001) with only 32.3% of New York patients vs 75.5% of non-New York patients (P < .001) taken for CABG within 3 days of shock onset.
In our propensity-adjusted retrospective analysis, New York patients with acute myocardial infarction and cardiogenic shock were less likely to undergo coronary angiography and PCI and waited significantly longer to receive CABG than their non-New York counterparts. These findings suggest that state-required reporting to the New York State Cardiac Surgery and Percutaneous Coronary Intervention Reporting System may result in the reluctance to revascularize the highest-risk cardiac patients.
研究表明，纽约州心脏手术和经皮冠状动脉介入治疗报告系统会公布接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）患者的术者特定死亡率，与其他州相比，这可能会使纽约的术者不愿为高危心脏病患者提供血运重建治疗。
我们对545例因主要左心室衰竭导致急性心肌梗死和心源性休克的美国患者进行了回顾性分析，这些患者均纳入了SHOCK注册研究。使用倾向评分法对病例组合进行调整后，我们比较了纽约州的220例患者和其他州的325例患者冠状动脉造影、PCI、CABG的使用情况及预后。
纽约州的患者年龄更大，基线特征相似或较轻。经过倾向评分调整后，纽约州患者接受冠状动脉造影（比值比0.46，95%可信区间0.31 - 0.68，P <.001）和PCI（比值比0.51，95%可信区间0.33 - 0.77，P =.002）的可能性低于非纽约州患者。冠状动脉旁路移植率同样较低（14.1%对15.1%，P =无显著差异），但纽约州患者在休克发作后等待手术的时间明显更长（101.2小时对10.3小时，P <.001），休克发作后3天内接受CABG的纽约州患者仅占32.3%，而非纽约州患者为75.5%（P <.001）。
在我们经过倾向调整的回顾性分析中，与非纽约州的患者相比，纽约州患有急性心肌梗死和心源性休克的患者接受冠状动脉造影和PCI的可能性较小，接受CABG的等待时间明显更长。这些发现表明，向纽约州心脏手术和经皮冠状动脉介入治疗报告系统进行州要求的报告可能导致不愿为最高危的心脏病患者进行血运重建。
