Consuegra-Sánchez Luciano, Jaulent-Huertas Leticia, Vicente-Gilabert Marta, Díaz-Pastor Ángela, Escudero-García Germán, Alonso-Fernández Nuria, Gil-Sánchez Francisco Javier, Martínez-Hernández Juan, Sanchis-Forés Juan, Galcerá-Tomás José, Melgarejo-Moreno Antonio
Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
Cardiology Department and Acute Coronary Care Unit, Universidad Católica de Murcia-UCAM, Hospital Universitario Santa Lucía de Cartagena, Spain.
Int J Cardiol. 2017 Jun 1;236:85-90. doi: 10.1016/j.ijcard.2017.02.148. Epub 2017 Mar 1.
Although the easy availability of invasive cardiac care facilities is associated with an increase in their use, their influence on outcomes is not clear. We sought to investigate whether a newly available cardiac catheterization laboratory (CCL) performing percutaneous coronary intervention (PCI) on a part-time (PT) basis might improve outcomes in patients with acute myocardial infarction (AMI).
This was an observational cohort study that included all consecutive patients with AMI admitted to a secondary-level hospital in Spain before and after the PT-CCL opened in January 2006: during 1998-2005 and 2006-2014, respectively. All-cause in-hospital and long-term mortality were the co-primary endpoints. In-hospital complications and length of stay were secondary endpoints. For the analyses, patients were stratified according to propensity-score (PS) quintiles.
A total of 5339 patients were recruited, and 50.3% were managed after the opening of the PT-CCL. The PT-CCL was associated with greater use of PCI (81.2 vs. 32.5%, p<0.001) and guidelines-recommended medication (all p<0.001), lower risk of recurrent angina (PS-adjusted RR=0.160, 95% CI 0.115-0.222) and shorter length of hospital stay (PS-adjusted RR for length of stay <8days=0.357, 95% CI 0.301-0.422). In patients with NSTEMI, PT-CCL was associated with improved long-term survival (PS-adjusted HR=0.764, 95% CI 0.602-0.970).
In patients with AMI, a new PT-CCL was associated with greater use of PCI and guideline-recommended medication, lower risk of recurrent angina and shorter length of hospital stay. In a subset of patients with NSTEMI, PT-CCL was associated with improved long-term survival.
尽管侵入性心脏护理设施的便捷可得性与这些设施使用的增加相关，但其对治疗结果的影响尚不清楚。我们试图研究一家新启用的兼职进行经皮冠状动脉介入治疗（PCI）的心脏导管实验室（CCL）是否可能改善急性心肌梗死（AMI）患者的治疗结果。
这是一项观察性队列研究，纳入了2006年1月兼职CCL启用前后在西班牙一家二级医院收治的所有连续性AMI患者：分别为1998 - 2005年和2006 - 2014年期间。全因住院死亡率和长期死亡率是共同主要终点。住院并发症和住院时间是次要终点。为进行分析，患者根据倾向评分（PS）五分位数进行分层。
共招募了5339例患者，其中50.3%在兼职CCL启用后接受治疗。兼职CCL与更多地使用PCI（81.2%对32.5%，p<0.001）和指南推荐药物治疗（所有p<0.001）、复发性心绞痛风险降低（PS调整后的RR = 0.160，95%CI 0.115 - 0.222）以及住院时间缩短（住院时间<8天的PS调整后的RR = 0.357，95%CI 0.301 - 0.422）相关。在非ST段抬高型心肌梗死（NSTEMI）患者中，兼职CCL与改善长期生存相关（PS调整后的HR = 0.764，95%CI 0.602 - 0.970）。
在AMI患者中，新的兼职CCL与更多地使用PCI和指南推荐药物治疗、复发性心绞痛风险降低以及住院时间缩短相关。在一部分NSTEMI患者中，兼职CCL与改善长期生存相关。
