Cardiovascular Institute, Department of Medicine, School of Medicine, University of Pittsburgh, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa, USA.
Circ Cardiovasc Interv. 2009 Feb;2(1):6-13. doi: 10.1161/CIRCINTERVENTIONS.108.825323. Epub 2008 Dec 15.
Percutaneous coronary intervention (PCI) has undergone rapid progress, both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking.
We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 percutaneous transluminal coronary angioplasty (PTCA) and 1997-2006 Dynamic Registries waves (wave 1: 1997-1998, bare-metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001-2002, brachytherapy; waves 4 and 5: 2004-2006, drug-eluting stents). Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9; wave 1, 2.7; wave 2, 2.8; wave 3, 1.9; wave 4, 2.6; wave 5, 2; P(trend)<0.001) and emergency coronary artery bypass surgery (PTCA Registry: 3.7; wave 1, 0.4; wave 2, 0.4; wave 3, 0.3; wave 4, 0.4; wave 5, 0; P(trend)<0.001). Compared with the PTCA Registry, risk for repeat revascularization (31 to 365 days after index PCI) was significantly lower in the dynamic waves (adjusted hazard ratio: wave 1, 0.72; wave 2, 0.51; wave 3, 0.51; wave 4, 0.30; wave 5, 0.36; P<0.05 for all).
Percutaneous interventions, in the last 2 decades, have evolved to include more urgent, comorbid cases, despite achieving high success rates with significantly reduced need for repeat revascularization.
经皮冠状动脉介入治疗（PCI）在技术和辅助治疗方面都取得了快速发展。然而，关于当代实践的长期时间趋势的文献记录却很少。
我们分析了多中心、美国国立心肺血液研究所（National Heart, Lung, and Blood Institute）赞助的 1985-1986 经皮腔内冠状动脉血管成形术（PTCA）和 1997-2006 年动态注册研究中的 8976 例连续患者的 PCI 使用情况和结果（波 1：1997-1998 年，裸金属支架；波 2：1999 年，支架的统一使用；波 3：2001-2002 年，放射性治疗；波 4 和 5：2004-2006 年，药物洗脱支架）。与球囊时代相比，最近几轮 PCI 中的患者年龄更大，且更常报告合并症。对于急性冠状动脉综合征，进行 PCI 的比例更高，尽管疾病负担更大，但选择性也更高。支架时代的手术成功率更高且更稳定。院内心肌梗死发生率（PTCA 登记处：4.9%；波 1：2.7%；波 2：2.8%；波 3：1.9%；波 4：2.6%；波 5：2%；趋势 P<0.001）和紧急冠状动脉旁路移植术（PTCA 登记处：3.7%；波 1：0.4%；波 2：0.4%；波 3：0.3%；波 4：0.4%；波 5：0%；趋势 P<0.001）显著降低。与 PTCA 登记处相比，动态波的再次血运重建风险（指数 PCI 后 31 至 365 天）显著降低（校正后的危险比：波 1：0.72；波 2：0.51；波 3：0.51；波 4：0.30；波 5：0.36；P<0.05）。
在过去的 20 年中，经皮介入治疗已经发展到包括更紧急、合并症更多的病例，尽管成功率很高，但需要再次血运重建的情况明显减少。
