University at Albany, State University of New York, Albany, NY 12144-3456, USA.
Circulation. 2010 Jan 19;121(2):267-75. doi: 10.1161/CIRCULATIONAHA.109.887539. Epub 2010 Jan 4.
The American College of Cardiology and the American Heart Association have issued guidelines for the use of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI) for many years, but little is known about the impact of these evidence-based guidelines on referral decisions.
A cardiac catheterization laboratory database used by 19 hospitals in New York State was used to identify treatment (CABG surgery, PCI, medical treatment, or nothing) recommended by the catheterization laboratory cardiologist for patients undergoing catheterization with asymptomatic/mild angina, stable angina, and unstable angina/non-ST-elevation myocardial infarction between January 1, 2005, and August 31, 2007. The recommended treatment was compared with indications for these patients based on American College of Cardiology/American Heart Association guidelines. Of the 16 142 patients undergoing catheterization who were found to have coronary artery disease, the catheterization laboratory cardiologist was the final source of recommendation for 10 333 patients (64%). Of these 10 333 patients, 13% had indications for CABG surgery, 59% for PCI, and 17% for both CABG surgery and PCI. Of the patients who had indications for CABG surgery, 53% were recommended for CABG and 34% for PCI. Of the patients with indications for PCI, 94% were recommended for PCI. For the patients who had indications for both CABG surgery and PCI, 93% were recommended for PCI and 5% for CABG surgery. Catheterization laboratory cardiologists in hospitals with PCI capability were more likely to recommend patients for PCI than hospitals in which only catheterization was performed.
Patients with coronary artery disease receive more recommendations for PCI and fewer recommendations for CABG surgery than indicated in the American College of Cardiology/American Heart Association guidelines.
多年来，美国心脏病学会和美国心脏协会发布了关于冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的使用指南，但对于这些循证指南对转诊决策的影响知之甚少。
利用纽约州 19 家医院的心脏导管实验室数据库，确定了在 2005 年 1 月 1 日至 2007 年 8 月 31 日期间，患有无症状/轻度心绞痛、稳定型心绞痛和不稳定型心绞痛/非 ST 段抬高型心肌梗死的患者接受导管插入术时，导管实验室心脏病专家推荐的治疗方法（CABG 手术、PCI、药物治疗或不治疗）。将推荐的治疗方法与这些患者的美国心脏病学会/美国心脏协会指南适应证进行比较。在接受导管插入术的 16142 例患有冠状动脉疾病的患者中，有 10333 例（64%）患者的导管实验室心脏病专家是最终推荐来源。在这 10333 例患者中，有 13%的患者有 CABG 手术适应证，59%的患者有 PCI 适应证，17%的患者 CABG 手术和 PCI 适应证均有。有 CABG 手术适应证的患者中，53%被推荐行 CABG，34%被推荐行 PCI。有 PCI 适应证的患者中，94%被推荐行 PCI。对于有 CABG 手术和 PCI 适应证的患者，93%被推荐行 PCI，5%被推荐行 CABG 手术。有 PCI 能力的医院的导管实验室心脏病专家更倾向于推荐患者行 PCI，而不是只进行导管插入术的医院。
患有冠状动脉疾病的患者接受 PCI 的推荐比美国心脏病学会/美国心脏协会指南适应证多，而接受 CABG 手术的推荐则较少。
