心梗后并发心搏骤停患者的管理：纽约市公共报告政策变化前后
Management of Patients With Cardiac Arrest Complicating Myocardial Infarction in New York Before and After Public Reporting Policy Changes.
机构信息
From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.).
出版信息
Circ Cardiovasc Interv. 2017 May;10(5). doi: 10.1161/CIRCINTERVENTIONS.116.004833.
BACKGROUND
In 2010, New York State began excluding selected patients with cardiac arrest and coma from publicly reported mortality statistics after percutaneous coronary intervention. We evaluated the effects of this exclusion on rates of coronary angiography, revascularization, and mortality among patients with acute myocardial infarction and cardiac arrest.
METHODS AND RESULTS
Using statewide hospitalization files, we identified discharges for acute myocardial infarction and cardiac arrest January 2003 to December 2013 in New York and several comparator states. A difference-in-differences approach was used to evaluate the likelihood of coronary angiography, revascularization, and in-hospital mortality before and after 2010. A total of 26 379 patients with acute myocardial infarction and cardiac arrest (5619 in New York) were included. Of these, 17 141 (65%) underwent coronary angiography, 12 183 (46.2%) underwent percutaneous coronary intervention, and 2832 (10.7%) underwent coronary artery bypass grafting. Before 2010, patients with cardiac arrest in New York were less likely to undergo percutaneous coronary intervention compared with referent states (adjusted relative risk, 0.79; 95% confidence interval, 0.73-0.85; <0.001). This relationship was unchanged after the policy change (adjusted relative risk, 0.82; 95% confidence interval, 0.76-0.89; interaction =0.359). Adjusted risks of in-hospital mortality between New York and comparator states after 2010 were also similar (adjusted relative risk, 0.94; 95% confidence interval, 0.87-1.02; =0.152 for post- versus pre-2010 in New York; adjusted relative risk, 0.88; 95% confidence interval, 0.84-0.92; <0.001 for comparator states; interaction =0.103).
CONCLUSIONS
Exclusion of selected cardiac arrest cases from public reporting was not associated with changes in rates of percutaneous coronary intervention or in-hospital mortality in New York. Rates of revascularization in New York for cardiac arrest patients were lower throughout.
背景
2010 年，纽约州开始将接受经皮冠状动脉介入治疗的心脏骤停和昏迷患者排除在公共报告的死亡率统计之外。我们评估了这种排除对急性心肌梗死和心脏骤停患者的冠状动脉造影、血运重建和死亡率的影响。
方法和结果
我们使用全州住院档案，在纽约和几个比较州识别 2003 年 1 月至 2013 年 12 月的急性心肌梗死和心脏骤停出院病例。采用差值法在 2010 年前后评估冠状动脉造影、血运重建和院内死亡率的可能性。共纳入 26379 例急性心肌梗死和心脏骤停患者（纽约 5619 例）。其中 17141 例（65%）接受冠状动脉造影，12183 例（46.2%）接受经皮冠状动脉介入治疗，2832 例（10.7%）接受冠状动脉旁路移植术。在 2010 年之前，纽约的心脏骤停患者接受经皮冠状动脉介入治疗的可能性低于参照州（校正相对风险，0.79；95%置信区间，0.73-0.85；<0.001）。政策变化后，这种关系并未改变（校正相对风险，0.82；95%置信区间，0.76-0.89；交互作用=0.359）。2010 年后，纽约和比较州之间的院内死亡率调整风险也相似（校正相对风险，0.94；95%置信区间，0.87-1.02；纽约为 2010 年后与 2010 年前相比；校正相对风险，0.88；95%置信区间，0.84-0.92；<0.001；比较州；交互作用=0.103）。
结论
将选定的心脏骤停病例排除在公共报告之外，与纽约经皮冠状动脉介入治疗或院内死亡率的变化无关。在整个纽约，心脏骤停患者的血运重建率较低。
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