Curtis Jeptha P, Rathore Saif S, Wang Yongfei, Chen Jersey, Nallamothu Brahmajee K, Krumholz Harlan M
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA.
Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):21-30. doi: 10.1161/CIRCOUTCOMES.110.960385. Epub 2011 Dec 6.
Intra-aortic balloon pumps (IABP) frequently are used to provide hemodynamic support during high risk percutaneous coronary intervention (PCI), but clinical evidence to support their use is mixed. We examined hospital variation in IABP use among high risk PCI patients, and determined the association of IABP use on mortality in this population.
We analyzed data submitted to the CathPCI Registry between January 2005 and December 2007. High risk PCI was defined as having at least 1 of the following features: unprotected left main artery as the target vessel, cardiogenic shock, severely depressed left ventricular function, or ST segment elevation myocardial infarction. Hospitals were categorized into quartiles by their proportional use of IABP. We examined differences in in-hospital mortality across hospital quartiles using a hierarchical logistic regression model to adjust for differences in patient and hospital characteristics across hospital quartiles of IABP use. IABPs were used in 18,990 (10.5%) of 181,599 high risk PCIs. Proportional use of IABP varied significantly across hospital quartiles: Q1, 0.0 to 6.5%; Q2, 6.6 to 9.2%; Q3, 9.3 to 14.1%; Q4, 14.2 to 40.0%. In multivariable analysis, after adjustment for differences in patient and hospital characteristics, in-hospital mortality was comparable across quartiles of hospital IABP usage (Q1, Ref; Q2, odds ratio 1.11, 95% CI 0.99-1.24; Q3, OR 1.03, 95% CI 0.92-1.15; Q4, OR 1.06, 95% CI 0.94-1.18).
IABP use varied significantly across hospitals for high risk PCI. However, this variation in IABP use was not associated with differences in in-hospital mortality.
主动脉内球囊反搏泵(IABP)常用于在高风险经皮冠状动脉介入治疗(PCI)期间提供血流动力学支持,但支持其使用的临床证据不一。我们研究了高风险PCI患者中IABP使用情况在医院间的差异,并确定了IABP使用与该人群死亡率之间的关联。
我们分析了2005年1月至2007年12月提交至CathPCI注册中心的数据。高风险PCI被定义为具有以下至少一项特征:以无保护左主干动脉为靶血管、心源性休克、严重左心室功能不全或ST段抬高型心肌梗死。根据IABP的使用比例将医院分为四分位数。我们使用分层逻辑回归模型来调整不同IABP使用四分位数医院间患者和医院特征的差异,从而研究不同医院四分位数的住院死亡率差异。在181,599例高风险PCI中,18,990例(10.5%)使用了IABP。IABP的使用比例在不同医院四分位数间差异显著:第一四分位数(Q1)为0.0%至6.5%;第二四分位数(Q2)为6.6%至9.2%;第三四分位数(Q3)为9.3%至14.1%;第四四分位数(Q4)为14.2%至40.0%。在多变量分析中,调整患者和医院特征差异后,不同医院IABP使用四分位数的住院死亡率相当(Q1为参照组;Q2,比值比为1.11,95%置信区间为0.99 - 1.24;Q3,比值比为1.03,95%置信区间为0.92 - 1.15;Q4,比值比为1.06,95%置信区间为0.94 - 1.18)。
高风险PCI中IABP的使用在不同医院间差异显著。然而,IABP使用的这种差异与住院死亡率的差异无关。