Tomai Fabrizio, De Luca Leonardo, Nejat Teimur, Corvo Pierfrancesco, De Persio Giovanni, Altamura Luca, Michisanti Massimo, Garofalo Mariano, Mazzotti Pier Vittorio, Proietti Fabrizio
U.O. di Cardiologia Interventistica, Dipartimento di Scienze Cardiovascolari, European Hospital, Roma.
G Ital Cardiol (Rome). 2010 Oct;11(10):783-8.
Hospitals without percutaneous coronary intervention (PCI) capabilities are used to transfer patients who need coronary angiography and/or PCI to other centers. In order to optimize economic resources and hospital bed management, PCIs might be performed with an in-service organization, with re-transfer to the community hospital immediately after the procedure. The aim of our study was to evaluate the safety of a consecutive, unselected series of in-service PCIs compared to PCIs performed in patients admitted to hospitals with cath-lab capabilities.
During 2008, 1030 PCI procedures were performed at the European Hospital and Aurelia Hospital: 905 in patients admitted to a hospital with PCI capabilities (Group I) and 125 (12%) with an in-service strategy (Group II) referring from the Città di Roma Hospital. All treatment protocols were preventively uniformed and standardized.
The two groups were statistically comparable in terms of baseline clinical characteristics and/or procedural findings, with the exception for older age (66 +/- 10 vs 70 +/- 10 years, p = 0.004) and a higher prevalence of acute coronary syndromes (56 vs 88%, p < 0.001) and femoral vascular access (94 vs 98%, p = 0.03) in Group II. The rate of left ventricular ejection fraction < or = 35% (20 vs 13%, p = 0.06), multivessel PCI (23 vs 19%, p = 0.4), and glycoprotein IIb/IIIa inhibitor use (15 vs 13%, p = 0.5) was similar between the two groups. Among patients treated with an in-service strategy, 2 (1.6%) were not transferred to the community hospital, because of hemodynamic instability. The in-hospital rate of major clinical events (death for cardiovascular causes, cerebrovascular events, urgent revascularization, stent thrombosis) was 0.75% and 0.8% (p = 0.8), 1.8% and 1% (p = 0.4) for periprocedural myocardial infarction, 1.7% and 1.9% (p = 0.5) for major bleeding, 1.1% and 1.6% (p = 0.6) for vascular complications, in Group I and II, respectively. Left ventricular dysfunction was the only independent predictor of major clinical events (p = 0.003).
A strategy of in-service organization for PCI presents a similar rate of in-hospital clinical events and complications compared to an overnight stay into a hospital with PCI capabilities. Such a strategy may be utilized in order to optimize economic resources and hospital bed management.
没有经皮冠状动脉介入治疗（PCI）能力的医院通常会将需要冠状动脉造影和/或PCI的患者转至其他中心。为了优化经济资源和医院床位管理，PCI可由在职机构进行，并在术后立即转回社区医院。我们研究的目的是评估与在具备心导管室能力的医院接受PCI治疗的患者相比，连续、未选择的在职PCI系列治疗的安全性。
2008年期间，欧洲医院和奥雷利亚医院共进行了1030例PCI手术：905例是在具备PCI能力的医院入院患者中进行的（第一组），125例（12%）采用在职策略（第二组），这些患者来自罗马市医院。所有治疗方案均预先统一并标准化。
两组在基线临床特征和/或手术结果方面在统计学上具有可比性，但第二组患者年龄较大（66±10岁对70±10岁，p = 0.004）、急性冠状动脉综合征患病率较高（56%对88%，p < 0.001）以及股动脉血管穿刺比例较高（94%对98%，p = 0.03）。两组间左心室射血分数≤35%的比例（20%对13%，p = 0.06）、多支血管PCI比例（23%对19%，p = 0.4）以及糖蛋白IIb/IIIa抑制剂使用比例（15%对13%，p = 0.5）相似。在采用在职策略治疗的患者中，2例（1.6%）因血流动力学不稳定未转回社区医院。第一组和第二组的院内主要临床事件（心血管原因死亡、脑血管事件、紧急血运重建、支架血栓形成）发生率分别为0.75%和0.8%（p = 0.8），围手术期心肌梗死发生率分别为1.8%和1%（p = 0.4），大出血发生率分别为1.7%和1.9%（p = 0.5），血管并发症发生率分别为
