有现场心脏手术支持和没有现场心脏手术支持的医院之间，急性冠状动脉综合征患者经皮冠状动脉介入治疗的临床结果。
Clinical outcomes of percutaneous coronary intervention for acute coronary syndrome between hospitals with and without onsite cardiac surgery backup.
作者信息
Akasaka Tomonori, Hokimoto Seiji, Sueta Daisuke, Tabata Noriaki, Oshima Shuichi, Nakao Koichi, Fujimoto Kazuteru, Miyao Yuji, Shimomura Hideki, Tsunoda Ryusuke, Hirose Toyoki, Kajiwara Ichiro, Matsumura Toshiyuki, Nakamura Natsuki, Yamamoto Nobuyasu, Koide Shunichi, Nakamura Shinichi, Morikami Yasuhiro, Sakaino Naritsugu, Kaikita Koichi, Nakamura Sunao, Matsui Kunihiko, Ogawa Hisao
机构信息
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
J Cardiol. 2017 Jan;69(1):103-109. doi: 10.1016/j.jjcc.2016.01.012. Epub 2016 Feb 23.
BACKGROUND
Based on the 2011 American College of Cardiology/American Heart Association percutaneous coronary intervention (PCI) guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, data suggest that there is no significant difference in clinical outcomes following primary or elective PCI between the two groups. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI for acute coronary syndrome (ACS).
METHODS AND RESULTS
From August 2008 to March 2011, subjects (n=3241) were enrolled from the Kumamoto Intervention Conference Study (KICS). Patients were assigned to two groups treated in hospitals with (n=2764) or without (n=477) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored in-hospital events, non-cardiovascular deaths, bleeding complications, revascularizations, and emergent coronary artery bypass grafting (CABG). There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery [ACS, 7.6% vs. 8.0%, p=0.737; ST-segment elevation myocardial infarction (STEMI), 10.4% vs. 7.5%, p=0.200]. There was also no significant difference when events in primary endpoint were considered separately. In other events, revascularization was more frequently seen in hospitals with onsite surgery (ACS, 20.0% vs. 13.0%, p<0.001; STEMI, 21.9% vs. 14.5%, p=0.009). We performed propensity score matching analysis to correct for the disparate patient numbers between the two groups, and there was also no significant difference for primary endpoint (ACS, 8.6% vs. 7.5%, p=0.547; STEMI, 11.2% vs. 7.5%, p=0.210).
CONCLUSIONS
There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.
背景
根据2011年美国心脏病学会/美国心脏协会经皮冠状动脉介入治疗（PCI）指南，建议应在有现场心脏手术的医院进行PCI。但是，数据表明两组之间在初次或择期PCI后的临床结果上没有显著差异。我们研究了有无现场心脏手术对急性冠状动脉综合征（ACS）PCI术后临床结果的影响。
方法与结果
2008年8月至2011年3月，从熊本介入会议研究（KICS）中纳入研究对象（n = 3241）。患者被分为两组，分别在有（n = 2764）或无（n = 477）现场心脏手术的医院接受治疗。对临床事件进行了12个月的随访。主要终点是住院死亡、心血管死亡、心肌梗死和中风。并且我们监测了住院事件、非心血管死亡、出血并发症、血运重建以及急诊冠状动脉旁路移植术（CABG）。有现场心脏手术和无现场心脏手术的医院之间在主要终点上没有总体显著差异[ACS，7.6%对8.0%，p = 0.737；ST段抬高型心肌梗死（STEMI），10.4%对7.5%，p = 0.200]。当分别考虑主要终点中的事件时也没有显著差异。在其他事件中，血运重建在有现场手术的医院中更常见（ACS，20.0%对13.0%，p < 0.001；STEMI，21.9%对14.5%，p = 0.009）。我们进行了倾向评分匹配分析以校正两组之间不同的患者数量，并且主要终点也没有显著差异（ACS，8.6%对7.5%，p = 0.547；STEMI，11.2%对7.5%，p = 0.210）。
结论
在日本，有和没有现场心脏手术支持的医院在ACS的PCI术后临床结果上没有显著差异。
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