O'Neill Darragh, Nicholas Owen, Gale Chris P, Ludman Peter, de Belder Mark A, Timmis Adam, Fox Keith A A, Simpson Iain A, Redwood Simon, Ray Simon G
From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.).
Circ Cardiovasc Qual Outcomes. 2017 Mar;10(3). doi: 10.1161/CIRCOUTCOMES.116.003186.
The relationship between procedural volume and prognosis after percutaneous coronary intervention (PCI) remains uncertain, with some studies finding in favor of an inverse association and some against. This UK study provides a contemporary reassessment in one of the few countries in the world with a nationally representative PCI registry.
A nationwide cohort study was performed using the national British Cardiovascular Intervention Society registry. All adult patients undergoing PCI in 93 English and Welsh NHS hospitals between 2007 and 2013 were analyzed using hierarchical modeling with adjustment for patient risk. Of 427 467 procedures (22.0% primary PCI) in 93 hospitals, 30-day mortality was 1.9% (4.8% primary PCI). 87.1% of centers undertook between 200 and 2000 procedures annually. Case mix varied with center volume. In centers with 200 to 399 PCI cases per year, a smaller proportion were PCI for ST-segment-elevation myocardial infarction (8.4%) than in centers with 1500 to 1999 PCI cases per year (24.2%), but proportionally more were for ST-segment-elevation myocardial infarction with cardiogenic shock (8.4% versus 4.3%). For the overall PCI cohort, after risk adjustment, there was no significant evidence of worse, or better, outcomes in lower volume centers from our own study, or in combination with results from other studies. For primary PCI, there was also no evidence for increased or decreased mortality in lower volume centers.
After adjustment for differences in case mix and clinical presentation, this study supports the conclusion of no trend for increased mortality in lower volume centers for PCI in the UK healthcare system.
https://www.clinicaltrials.gov. Unique identifier: NCT02184949.
经皮冠状动脉介入治疗（PCI）后手术量与预后之间的关系仍不明确，一些研究发现二者呈负相关，而另一些研究则持反对意见。这项英国研究在世界上少数几个拥有全国代表性PCI登记系统的国家之一进行了当代重新评估。
使用英国心血管介入学会国家登记系统进行了一项全国队列研究。对2007年至2013年间在93家英格兰和威尔士国民健康服务医院接受PCI的所有成年患者进行分层建模分析，并对患者风险进行调整。93家医院的427467例手术（22.0%为直接PCI）中，30天死亡率为1.9%（直接PCI为4.8%）。87.1%的中心每年进行200至2000例手术。病例组合因中心手术量而异。每年进行200至399例PCI手术的中心，因ST段抬高型心肌梗死接受PCI的比例（8.4%）低于每年进行1500至1999例PCI手术的中心（24.2%），但因ST段抬高型心肌梗死合并心源性休克接受PCI的比例相对较高（8.4%对4.3%）。对于整个PCI队列，在风险调整后，无论是本研究中手术量较低的中心，还是与其他研究结果相结合，均无显著证据表明其预后更差或更好。对于直接PCI，也没有证据表明手术量较低的中心死亡率增加或降低。
在对病例组合和临床表现的差异进行调整后，本研究支持以下结论：在英国医疗系统中，手术量较低的中心PCI死亡率没有增加的趋势。
