Blumenfeld Orit, Na'amnih Wasef, Shapira-Daniels Ayelet, Lotan Chaim, Shohat Tamy, Shapira Oz M
Israel Centers for Disease Control, Ministry of Health, Ramat Gan, Israel
Israel Centers for Disease Control, Ministry of Health, Ramat Gan, Israel.
J Am Heart Assoc. 2017 Feb 17;6(2):e004734. doi: 10.1161/JAHA.116.004734.
We investigated national trends in volume and outcomes of percutaneous coronary angioplasty (PCI), coronary artery bypass grafting (CABG), and ischemic heart disease-related mortality in Israel.
Using 9th and 10th revision codes, we linked 5 Israeli national databases, including the Israel Center for Disease Control National PCI and CABG Registries, the Ministry of Health Hospitalization Report, the Center of Bureau of Statistics, and the Ministry of Interior Mortality Report, to assess the annual PCI and CABG volume, procedural mortality, comorbidities, and ischemic heart disease-related mortality between 2002 and 2014. Trends over time were analyzed using linear regression, assuming a Poisson distribution. A total of 298 390 revascularization procedures (PCI: 255 724, CABG: 42 666) were performed during the study period. PCI volume increased by 9% from 2002 to 2008 (387.4/100 000 to 423.2/100 000), steadily decreasing by 10.5% to 378.5/100 000 in 2014 (=0.70 for the trend). CABG volume decreased by 59% (109.0/100 000 to 45.2/100 000) from 2002 to 2013, leveling at 46.4/100 000 (<0.0001). PCI/CABG ratio increased from 3.6 in 2002 to 8.5 in 2013, slightly decreasing to 8.2 by 2014 (<0.0001). In-hospital procedural mortality remained stable (PCI: 1.2-1.6%, =0.34, CABG: 3.7-4.4%, =0.29) despite a significant change in patient clinical profile. During the course of the study, ischemic heart disease-related mortality decreased by 46% (84.6-46/100 000, <0.001).
We observed a dramatic change in coronary revascularization procedures type and volume, and a marked decrease in ischemic heart disease-related mortality in Israel. The reasons for the observed changes remain unclear and need to be further investigated.
我们调查了以色列经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）的手术量及结果，以及缺血性心脏病相关死亡率的全国趋势。
我们使用第9版和第10版编码，将5个以色列国家数据库相链接，包括以色列疾病控制中心国家PCI和CABG登记处、卫生部住院报告、统计局中心以及内政部死亡率报告，以评估2002年至2014年间每年的PCI和CABG手术量、手术死亡率、合并症以及缺血性心脏病相关死亡率。采用线性回归分析时间趋势，假设为泊松分布。在研究期间共进行了298390例血运重建手术（PCI：255724例，CABG：42666例）。PCI手术量从2002年到2008年增加了9%（从每10万人387.4例增至423.2例），到2014年稳步下降10.5%至每10万人378.5例（趋势值=0.70）。CABG手术量从2002年到2013年下降了59%（从每10万人109.0例降至45.2例），2013年稳定在每10万人46.4例（<0.0001）。PCI/CABG比例从2002年的3.6增至2013年的8.5，到2014年略有下降至8.2（<0.0001）。尽管患者临床特征发生了显著变化，但住院手术死亡率保持稳定（PCI：1.2 - 1.6%，=0.34；CABG：3.7 - 4.4%，=0.29）。在研究过程中，缺血性心脏病相关死亡率下降了46%（从每10万人84.6例降至46例，<0.001）。
我们观察到以色列冠状动脉血运重建手术类型和手术量发生了显著变化，缺血性心脏病相关死亡率显著下降。观察到的这些变化的原因尚不清楚，需要进一步研究。
