Shiraishi Jun, Kohno Yoshio, Sawada Takahisa, Arihara Masayasu, Hyogo Masayuki, Yagi Takakazu, Shima Takatomo, Okada Takashi, Nakamura Takeshi, Matoba Satoaki, Yamada Hiroyuki, Shirayama Takeshi, Tatsumi Tetsuya, Kitamura Makoto, Furukawa Keizo, Matsubara Hiroaki
Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
Circ J. 2008 Jul;72(7):1041-6. doi: 10.1253/circj.72.1041.
Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan.
Using the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as low-volume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class >or=3 at admission, multivessel disease or left main trunk (LMT) as culprit lesion, number of diseased vessels >or=2 or diseased LMT, and age were the independent positive predictors of in-hospital mortality, whereas the TIMI flow grade 3 after primary PCI and elapsed time <24 h were the negative ones, but not low-volume hospital.
Angiographic results of primary PCI in high-volume hospitals were superior to those in low-volume hospitals, but there was no significant difference in the in-hospital mortality between AMI patients in high-volume hospitals and those in low-volume hospitals.
多项临床研究表明，原发性经皮冠状动脉介入治疗（PCI）的医院手术量与住院死亡率之间存在负相关关系。然而，在日本，医院原发性PCI手术量、血管造影结果与急性心肌梗死（AMI）患者住院预后之间的关系尚未得到充分研究。
利用2000年1月至2005年12月期间的AMI-京都多中心风险研究数据库，根据各医院原发性PCI的年手术量将医院分为五等份。手术量最高的五分之一医院被标记为高手术量医院，其他五等份医院合并定义为低手术量医院。与低手术量医院（低手术量组，n = 1021）的患者相比，高手术量医院接受原发性PCI的患者（高手术量组，n = 764）在初次冠状动脉造影时病变血管数量更多，PCI术前梗死相关动脉的心肌梗死溶栓（TIMI）血流分级更低，但高手术量组PCI术后即刻达到TIMI 3级血流的比例显著高于低手术量组。两组的总体住院死亡率无差异。多变量分析显示，在接受原发性PCI的AMI患者中，入院时Killip分级≥3、多支血管病变或罪犯病变为左主干（LMT）、病变血管数量≥2或病变LMT以及年龄是住院死亡率的独立阳性预测因素，而原发性PCI术后TIMI 3级血流以及发病时间<24小时是阴性预测因素，但低手术量医院不是。
高手术量医院原发性PCI的血管造影结果优于低手术量医院，但高手术量医院的AMI患者与低手术量医院的患者在住院死亡率方面无显著差异。
